HomeMy Public PortalAbout5947 TEMPLE CITY BLVD_Sewer__ or COUNTY ptgpn= SEWER—SEWAGE. DISPOSAL
DIVISION OF BUILDING"ANDISAFETY PERMITP CATION
COUNTY OF i0S ®N6;E=M
WILLIAM J. FOX, COUNTY ENGINEER yI ADDRESS V V 7 C,
LOCALITY
,FOR APPLICANT TO FILL IN _
ADDRESN,40,� � y CROSS ST.
LOCALITY n DISTRIC-T-NO. Ready for Inspection [PERMIT NO.
NEAREST
` ( I 7�o� S
CROSS'ST. � /�/1/W �j RECEIVED BY DATE ISSUED BY DATE
OWNER c�r4�: �? I'm /-/W6g=iG
ADIL
DRESS USE ZONE OCCUPANCY fBK MAP PG
CITY r TELNO. C. 0 fFe
CONTRACTOR p HA/ j h V)E. H CO.IMP.N0.
ADDRESS �� e�• Nom' JO N0.
CITY l�O jf/ TEL.NO A �' L99 TRUN ERMIT NO.
REGISTRATION N0. �-Y �� RTE
87A �
ROAD PER T NO.
LEGAL J=. 0. ® STATE ENCR CHMENT
DESCRIPTION LOT N0. .a+ i;
PERMIT NO.
BLOCK TRACT INDUSTRIAL
/ WASTE APPROVAL
SIZE OF LOT �Y �`7��'NOW ON LOTS• F CHAR
.G
USE OF
BUILDINGS '(74#- CONNECTION CHARGE FEE
NO. DES.CRIPTIpN OF WORK FEE li
HOUSE SEWER CONNECTING TO - REIMBURSEMENT FE
PUBLIC SEWER @ $ 5.50 ,S �+, RECEIPT N0. D'AT I BY
HOUSE SEWER CONNECTING TO f
_ PRIVATE DISPOSAL SYSTEM 1.00 $
CONNECT ADDITIONAL BLDG.OR i EXCEPTION RECORDE
WORK TO HOUSE SEWER 1.00 t,
ALTER OR REPAIR EXISTING NO-' I DATE
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 7 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR t u
PITS AND/OR DRAINFIELD 2.00 STATION��L-� /' f' DEPTH / a
CESSPOOL—DRYW ELL o
SPECIAL CONDITIONS ONLY 2.00 ���� a MANHOLE-REFERENCE
UJB LOWER
TYPE OF CONNECTION LENGTH FROM -+v
CURB-- P.L. M.L..TO P.L. L6
OWNERS PERMIT $ 1 OOri - - — --
AUTHORIZATION I TOTAL FEE 5' '� _4
1 NAMED
THIS DATE CONTRACTED WITH THE HEREIN NAED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INBPECTOR'381GNATURE DATE
SIGNED THIS DAY OF.� � 19=?� EW HOUSE SEWER
OWNER OR �y A I v CONNECT ADDITIONAL
OWNERS AGENTC!f'�t._.�_7 BUILDING OR WORK
ADDRESS... `, � J._,.L..(. �t _v, ._._.. /,,� =-BEFrTIC TANK.BEEP..PIT(S)_,.,. +`
F, AND/OR•D RAINFI.EL.D
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-5 CESSPOOL[] DRYWELL
CATION.AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWSALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY-REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY;
AND STATE OF CALIFORNIA-OR THAVI)ANIAHE•LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE yvSEEP.PIT(S)[] CESSPOOLS
OF PERMITTEE__._—.=''��A a
7GA042D S&E 668 4/54 t