Loading...
HomeMy Public PortalAbout6018 TEMPLE CITY BLVD_Sewer__ OFPARTAIENT OF COU.NTB ENGINEER •SEWEEt- E1AlAC�E DISPOSAL 1 DIVISION OF.BUILDING AND SAFETY � PERMIT APPLICATION COUNTS OF LOS ANGMMES WILLIAM J. FDX, COUNTY ENGINEER I ADDRESS LOCALITY t FOR APPLICANT!TOO FILL INBUILD ` ADDRENG SS ���,�•^I f�'IH+ /"/y+ •c�d/"T.�. N 088 ST. LOCALITY may,/ ��a, J� (� DISTRICT N0. SERIAL NQ.(� PERMIT NO. CROSS ST. �� �f'Z.+�L' �R/�CYNL��it,F � ✓ -C� A-/63177 Y �S� S R CE VED B Ready for Inspection DATE ISSUED OWNERMAIL , y ADDRESS (a n / { USE ZONE OCCUPANCY B -M4w-PO CIT TEL.NO. I I .� CONTRACTOR �+�.,�.���� C=1�4�'�(. CO.IMP.NO. ADDRESS / ` Gu%'C� JOB.N0. CITY TEL.NO. LJ �30TRUNK PERMIT N0. STATE REGISTRATION NO. 1j 2CI� elV B-C 11ALTY ROAD PERMIT N0: LEGAL � � STATE ENCROACHMENT DESCRIPTION LOT N0. LLQ PERMIT NO. BLOCK TRACT INDUSTRIAL 1 WASTE APPROVAL S NO.OF BLDGS. SIZE OF LOT ; CHARGES NOW ON LOT USE OF Fti y/ CONNECTION CHARGE F E,. BUIL-QINGS �� �.�l�•� �"�L-.G�r• NO. DESCIZIPTION OF WORK FEE (f •REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER 0 $ 8.60 RECEIPT NO. I DATE / IBY HOUSE SEWER CONNECTING TO f PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONALBLDG.OR /�,. EXCEPTION R�ORDED WORK TO HOUSE SEWER 1.00 U t l ALTER OR REPAIR EXISTING NO' IATE\ 113Y SEWER OR DISPOSAL SYSTEM 1.00 AN% NABANDON SEWER ORDISPOSALYSTE 1,00 1 CON ECTION DATA SEPTIC TANK,SEEPAGE PIT OR \ PITS AND/.OR DRAINFIELD 2.00 STATION / DEPT CESSPOOL—ORYW ELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE RREFERENCEUPPLOWER TYPE OF CONNECTION LENGTH FROM OWNERS I PERMIT $ 1 00 Y. CURB P.L. M.L.TO.P.L. AUTHORIZATION TbTAL FEE '7 CONTRACTOR TO CONNECT CONTRACTED ABOVE DESCRIBED EXISTING APPROVALS. INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS.----DAY OF _--19— NEW HOUSE SEWER CONNECT ADDITIONAL OWNER OR OWNERS AGENT--_-..-..-.—._..—._._.._.._ BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS......... AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL DRYWELL CATION AND STATE THAT THE ABOVE 18 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 I AM PROPERLY .REGISTERED: DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY 'LOS-ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT:I AM',THIE-LEGAL-OWN.' ABANDON HOUSE-SEWER ER OF THE ABOVE DESCRIBED RESID.ENTIAI:SPROPERTY'. BACKFILLSEPTIC TANKS � •.l-'��I `i SEEP.PIT(S)[] CESSPOOLS E] SIGNATURE �'7 Gtr - OF PERMITTE .. -.L.. ._s._......�.._. _....e :` .: vaeaene aaR visa :i' 77m. .�!/