HomeMy Public PortalAbout5949 TEMPLE CITY BLVD_Sewer__ OF °O'er VADDBM
WAGE DISPOSAL
DrVZBM of 8�� AND SAFEPERMIT APPLICATION
OOvNW OW Los s>,CML=
WILLIAM J. FOX, Ooumm EMMINNENDBIG I.
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FOR A CANT R IN /'Q/�� LDDALmr
AADDO MDING /M� Naiop sir.
LOGALTTY DISTINCT NO. SERAL md.V PROMITAIL
NEAREST A 5 D 8.'L S
CROSS Bi
h VED�BY MSy IYr INwtMll DATE ISSUED
MAIL
M 11-3044 USE ZONE Cu I MAP MOITY wCt TEL.NO. `"_ � -0.
OONTRAC" 00.IMF.N0. I8
ADDRESS O JOM.NO. ---�
CITY TaL.No' 2— TRUNK PERMIT M0. r+
RESISTRIITW -mb. f COUNTY ROAD PERMIT N0.
LUAL
OESOMPTION LOT NO. STATE
PERNIT EN0.NOROACNMINT
BLOCK TRACT 16��� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT I Now 011 ATTR" 'I WARSES
B�UILDIMGS +'"�4 OOIINEOTION ON E FEE
N0. DE813RIP TION OF WCRK FEERUBEREIMBUBSENENt FEE
a TO
P BLIOSEWERLU as &w RECEIPT 00. Te qY
NO SE E CONNI
PRIVATE DISPOSAL SYSTN EM IA
WORK TO HOUSE me fig
figUM ON EK0EPT1 REC DED
ALTER 01 REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM IAM
ON
ANDiOR DIS�POMi sTEE R Lie OON ON DATA
NPT RTANR SEEPAS P 0
PITS AND ORbMINFIELD
am STATION- d, DEPTHU�OU �p
SPECIAL NDITIONS ONLY !Ae / ��!l����!!!.V...III / SIA PER
TYPE
ERENCE
E OFA EOTIO a L P�M O
To
OWNERS PERmrr $I 1 00
AUTHORIZATION TOTAL FEE F V6 55
1 NAYS THIS DATE VONTRAHED WITH TNN HEREIN NAMED APPROVALS IMSPECTorsBIBMATu■E DATE
DWELLING TO THE PUSUO MWABOVE Dp0R16ED EXISTIMS
SIGNED THIS DAY OF 19_. NEW NOOSE sEWEN *00 L '
OWNER OR OONNECT ADDITIONAL ,
OWNERS ABE BUILDING OR WORK
SEPTIO ESS � TANNSEEP.P
ADDR _ "" AND/02 DRAI NFIELDITq)
1 HEREBY ACKNOWLEDGE THAT 1 NAYS REAM VNIs APPY- CESSPOOL 0 BwYWELL 0
OATIOM AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWB ALTER RSPAI SSWEB OR
REGULATING PLUMBING AND SEWERS. Add DISPOSAL SYSTE
1 HEREBY ORNTIFY THAT 1 AN PROPERLY REYRTENED DISCONNECT PWB AND
AND ESTATE OF OALIFORN1AU10sETRAT IIAAN TNF LEGAL OWN A NDON HOUssamon[�
ER OF THE ANDY DESOBIBEQ DEM L PROP STY. SEEF.PIT � OESSl10QLT
OF PEMITTEE ��� J
TiANlD eee .� Lir�
TEM4�
gABa � APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS :•�:
JOIN A. L2iMBIE, Count' En neer
CASSATT D. GRIFFIN, Supt of Building !LOCALITY
NEAREST
FOR APPLICANT TO FILL IN cRosS sT.
LEGAL
DF,SCRt'pT;ON -LOT NO. OWNER _
BLOCK TRACT —MAIL
ADDRESS
NO.OF BLDGS.. -
51XE OF LOT NOW ON LOT - CITY
TEL. tin. -
USE OF
-
BUILD[NGS DISTRICT NO. GROUP BK MAP PG PROCESSED:'3Y
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL.NO,•. STATION '. DEPTH
STATE MANHOLE REFEREE E., _UPPED
_REGISTRATION 1-40. { ,�" COUNTY
L'.SGRi?7lOq7lF WORK`
LHOUSE SEWER CONNECTING TO
�_PUDLIC SEWER._ C� $3.00 - _ _ -
TYPE OF CONNECTION 'LENGTH PROM ,
SEPTIC TANKSEEPAGE PIT OR
, Y. CURB P.L. M1?) Tv a.L.
_{ PITS AN:D/OR DRAINFIEL_D (�+�.$3.00 ----
OVERFLOW SEEPAGE Pi T,DRAINFIELD
EXTN.. CF55PO01-DRYWELL @ $2.00 _
{ HOUSE SE VER CONNECTING TOP.C,NO,
I PR ;ED
tVA [SPOSkLM SYSTES1.00 Co. IMP. NO.
.'� JO NO,
CONNECT ADOiTION.AL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
A.t.T>„i3,.. ; ABANDON HOUSE i STATE ENCROACHMENT i�p�__ .
SEk EF. (,TAL SYSTEM @ $i-OO PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
I
_ GHARGES
OvmE s PERMIT s 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TTOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON
TRAC,OI? TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE '.NSPEC'TOR'S SIGNATURE
TO THE PU81.,Ic SEWER.
SIGNED THIS--DAY OF 19®_..'� NEW HORSE SEWER
OWNER OR CONNECT ADDITIONAL
..OWNERS AGENT_ _HUILDING OR WORK
SEPTIC TANK,SEEP.PIS) I
ADDRESS__ TAND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL L1 ARY`NrL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGtL
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER.OR '
SEWAGE DISPOSAL SYSTEM '
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAG DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF SEWER
E ABANDON HOUSE CALIFORNIA. OR THAT I AM THE LEGAL OWNER OF THE ABOVE BACKFILL OUSE TANKS ❑ +
DESCRIBED RESIDENTIAL PROPERTY.
SIGNATURE SEEP,PIT(S) , CE2SP06LS r
OF PERMITTEE
VALIDATION ROBERT A. WOOD
C& Y.O. CASf-s SUPERVISING MECHANICAL ENGI*rI=R