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Home My Public Portal About6036-6038-6038 1/2-6038 3/4 TEMPLE CITY BLVD_Sewer__ 7CA6420 E-663 W2.54 APPLICATION FOR PERMIT DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer v, — County of Los Angeles BUILDING -zl R BUILDING —ADDRESS-NGINEER WM.J. FOX. COUNTY F _ADDRESS L LIT, CASSATT 0. GRIFFIN, SUPT OF OUILDING LOCALITY" FOR APPLICANT TO FILL IN NEAREST CROSS�ST. LEGAL -DESCRIPTION R tL11 ON OT tL OWNER BLOCK TRACTMAIL ADDRESS — , NO.OF BLOCS. . 14OW ON LOT CITY�' -.,, - , l /," `-„TEL. USE OF EL. N0. ------- BUILDINGS DISTRICT NO.7— GROUP j M A P gK PG CONTRACTOR 41 ADDRESS gy: CONNECTION DATA CITY TEL. NO. STATION DEPTH - ' ------------ STATE MANHOLE REFERCNCE REGISTRATION NO, C'iCOUNTY LOWER zr TYPE OF CONNECTION LENGTH FROM NO. I DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER Rv $ 3.50 HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR Co. kA p. NO. JOB. NO. WORK TO HOUSE SEWER 1.00 1 1 PIR IR'EXiSTING f SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO. ROAD PERMIT NO. I DiSCONNECT AND ABANDON SEWER i STATE ENCROACHENT AND/OR wSrOSAL SYSTEM -.,.Do I i MPERMI_ PERMIT NO, SFPTIC TANK, SEEPAGE PIT OR -jTS AND OR DRAINFiELD 2,00 1NrUSTR'AL 1 CESSPOOL- DRYWELL WASTE APPROVAL E SL CONDiTIORS ONLY _,Do CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ AUTHORIZATION TOTAL FEE RE”M B UPSE M ENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE A90VE DESCRIBED EXISTING DWELLING APPROVALS DATEINSPECTOR'S SIGNATURE __ TO THE PUBLIC SEWER 1� --I , -- NEW HOUSE SEWER SIGNED THIS DAY OF OWR NEOR CONNECT ADDITIONAL OWNERS AGENT'ENT— -BUILDING OR WORK SEPTIC TANK, SEEP. PIT(S) AND/OR DRAINFIELD IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWELL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH AL'L COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR � AND SEWERS. SEWAGE DISPOSAL SYSTEM PLUMBING I HEREBY CERTIFY THAT I AM. PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ___ABANDON HOUSE SEWER....... DESCRIBED RESIDENTIAL P R 0 P F R,Y. BACKFILL SEPTIC TANKS 0 SEEP.PIT(S) 0 CESSPOOLS 0, SIGNATURE OF PERMITTEE WILLIAM J. FOX,COUNTY ENGINEER VALIDATION 0- 2 5 -2 n rEB 7 4 4.50 r By DEPUTY DEPUTY BY By DEPUTY DEPUTY E-6S 12.54 6&E•66APPLICATION. FOR PERMIT 1 6 do DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los AngelesBIiILDING WM.J. FOX. COUNTY ENGINEER ADDRESS ,r d �dE;. CASSATT D. GRIFFIN,SUPT OF SUILI)mG LOCALITY n .✓'�_., a FOR APPLICANT TO FILL IN NEAREST CROSS 5T. LEGAL DESCRIPTION LOT ..OWNER BLOCK TRACT MAIL '1 r ADDRESS r' NO.OF BLDCS. _SIZE OF LOT :c ° /. NOW ON LOT ' _._._ t.' CITY TEL. NO. USE OF y BUILDINGS ..�, er -��✓ DISTRICT NO. GROUP MAP __ --- ; BK PO CONTRACTOR �� ,..- ADDRESS CONNECTION DATA CITY -,r ... ,�,rrEL, h0 STATION DEPTH _.-- - _ __. [C` TATE MANHOLE REFERENCE REGISTRATION NO.4 CCOURTY _ 1 UPPER � LC_�YrER__ �TYPE�(3FCONNECTION LENGTH FROM Na. I DESCRIPTION OF WORK PEE Y. 'uRS P.L. —MSL TO P.L -- -� __ _____ 'HCUSE SEWER CONNECTING 70 i_PUBLIC SENER_.-_ _ C% $ 3.50 HOUSE SEWER CONNECTING 70 PRIVATE DISPOSAL SYSTEM _ 1.00 CONNECT ADDITIONAL,BLDG, OR WORK_T_O HOUSE SEWER_ t.00 r _ �'� CO. IMP, NO. 'OB. NO. ALTER OR REPAIR EXISTING I__�-- _ SEWER OR DISPOSAL SYSTEM 1.00 i l� TRUNK PERMIT NO. 'RQ AD PERMIT NO, DISCONNECT AND ABANDON SEINER STATE ENCROACHMENT CH �! ANDOR DISPOSAL SYSTEM 1.00PERMIT N0, 1 ^f STIC AHK,SEEPAGE PIT OR -� EP PITS_AN_D`OR DRA_3NFIELD 2.00 INDUSTRIAL �ICESSPOS --OL DRYF"TELL�. ---' WASTEAPPROVAL SPECIAL CONDITIONS ONLY 2.00 ! I CHARGES ' PERMT i CONNECTION CHARGE FEE ER O%VNt Do — — — --- -- AUTHORIZATION �TOT14I. FEE REIMBURSEMENT FEE - I HAVE TIIIS DATE CONTRACTED WITH THE HEREIN NAMED CON- r APPROVALS DATE IiiSP[C7'OR'5 SIGNATURE TO CONNECT THE AVOYE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEINER -----_-- "' ----" NEW HOUSE SEWER � SIGNED THIS *_DAY OF T _ �___19_-- _-- -- -- OWNER OR "� - jf CONNECT ADDITIONAL BUILDING OR WORK 01'JHERS AGcYT' L_ d:. �_._. -.- -- _—. -. .._. ADDRESS. SEPTIC TANK, SEEP, PIT(S) —_-__-_---`-_--'— _ •-AND/OP. DRAIN_FIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[3DRYWELL AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY Wi'TH ALL COUNTY ORDINANCES AND STATE LAWS REULATING ALTER, RE-PAIR,SEWER OR PLUMBING AND SEWER'S, SEWAGE_DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF' CALFFORNtA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑� SEEP. Q POOLS PIT(S) ❑ CESS SIGNATURE —.SPOOLS 0 OF PERMITTEE .4 WILLIAM J. FOX,COUNTY ENGINEER VALIDATION BY '' Y 4 a'R, J D 2.00 � DEPUTY �"`v' DEPUTY BY BY 16 " C r DEPUTY DEPUTY