HomeMy Public PortalAbout6003 TEMPLE CITY BLVD_Sewer__ DEPARTB ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
UILDING WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS Cp �� �, *✓�I�J.MA,� ./fel?' w�l
NG FOR APPLICANT TO L INI LOCALITY NEAREST
ADDRESS FI•SS ®® �t/�f/� G CROSS ST.
LOCALITY
DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST.
Q R Et ED BY Ready for Inspection DATE ISSUED
OWNER % / 4 6
MAIL 1 USE ZONE OCCUPANCY gK--MAP—
ADDRESS.- . v PG
CITY TEL.NO. , ��
CONTRACTOR T ,ems- _r 19 CO.IMP.NO.
ADDRESS JOB NO. ----
CITY TELNO. TRUNK PERMIT NO.
REGISTRATION / V,:] / COUNTY ROAD PERMIT NO. 74 c� s-ts
LEGAL �..s
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO. ��
BLOCK TRACT " INDUSTRIAL ®_
®� n WASTE APPROVAL
SIZE OF LOT N0.OF BL To
NOW ON LOZ, CHARGES
USE OF Q r CONNECTION CHARGE FE
BUILDINGS A Awa & Q_A tC;�'�f°
NO. DESCRIPTION OF,,VMRK FEE f'
HOUSE SEWER CONNECTI 0 TO v REIMBURSEMENT FEE
PUBLIC SEWER 0 $ 8.50 RECEIPT NO.. I D E I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM. 1.00
CONNECT ADDITIONAL BLDO.OR EXCEPT N ECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DA E I BY
SEWER OR DISPOSAL SYSTEM_ 1.00
DISCONNECT AND ABAND
AND/OR DISPOSAL SYSTEM SEWER 1,00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION ¢ 7 p? DEPTH
CESSPOOL—D RY W ELL r
8PECIAL CONDITIONS ONLY 2.00 D MANHOLE REFERENCE
sAl tiPPE'Rk— LOWER
TYPE OF CONNECTION LENGTH FROM �y ¢t
OWNERS PERMIT ; I 00 _y_ CURB .sP Lr— M.L.TO P.L. o�C /J
AUTHORIZATION I TOTAL FEE 1 4-1 5D
1HAVE TTHIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_. DAY OF..._ =. NEW HOUSE SEWER �I&Ofjfi
/�� � CONNECT ADDITIONAL V-
OWNER OR //_ 1 �/1� ,�j� � BUILDINGORWORK
OWNERS AGENT.. .��:G�,-.W.
i...._:..�.._...:......_....:.._,
L - L:• SEPTIC TANK,SEEP.PIT(S)
ADDRESS....�i\ _���..�:y. ,G�=:n.^..4 * S`;Ll._.:_tl
•t—•-J•,---• AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-. CESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY'ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
NTYDISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS -ANGELES 'COU • ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE A:BO;.VE DE IBED RES DEN AL PROPERTY. BACKFILL SEPTIC TANKS �(�i /
! SEEP.PIT(S)❑ CESSPOOLS �[ jig (z
SIGNATURE I.y 9� �j � v -
OF PERMITTE
76A642A 663 7/58 (° til.,.c•7rf�Ir VK