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
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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 :` .:
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