HomeMy Public PortalAbout6111 TEMPLE CITY BLVD_Sewer__ 'B" -66
E�eaa�.a� APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER--SEWAGE DISPOSAL
Department of County Engineer �
County of Los Angeles BUILDING
WM.J. FOX.COUNTY ENGINEER _ADDRESS,
OASSATT O.GRIFFIN,SUP"Y'OF BUILDING LOCALITY4
FOR APPLICANT TO FILL IN NEAREST `
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- CROSS ST_��T�$.••'Yr'"�"':".�"�_�'`�-a�
LEGAL e
DESCR[PTIgN L07 NO. OWNER 'I,,y'{,�j
BLOCK TRACT
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ADDRESS .{r :J` '� �'"`C.✓ 'a.- .- .__.�.r
J''�O, 11F BLDGS. ��"�v,
SIZE OF LDT' r-'' s NOW 6N LOT A ,?r
CITY 3' " TEL.N0,
USE OF
BUILDINGS DISTRICT NO° 4 GROUP MAP
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CONTRACTOR �;' I�- ',j-,-� z -f' 4-- ,......7••. .�
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ADDRESS / ', CONNECTION DATA
CITY r,,.,_ i'�: - TEL. N0. o� . `; �+ r/ 3 .STATION - fyK, DEPTH -
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.'STATE MANHOLE REFERENCE P
REGISTRATION NO. 'y .-, 'k � ; � E COUNTY
No.I DESCRIPTION OF'VORK FEE
HOUSE
SEWER COF NECTi NG TO �-- TYPE 0 r. V13£C71CN LENGTH FP0;,1
pd BL1C
SEWER ch $ 3 50 y"j E0 CUR _ , I,,L.TOP L—_,_ -
HOUSE SEXY R CONtiECTING TO
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_ PR1,•ATE DISPOSAL SYSTEM 1.00
-- f,NNECT ADDdT10NAL BLDG. OR — -- -�_ 7 -7-7 P. C NO.
WORM TO HOUSE SEWER_. 1.00 CO. iMP N.O.J,.�"JY __
_—
SEWER OR DISPOSAL SYSTEM __ 1.00 TRUNK PERMIT NO. ROAD PERMIT NO,
UI CONNECT AND ABANDON SEWER �^ STET ENCROACHMENT. _ -- -----
A dD.'"Ot
DISPOSAL SYSTEM, — _ 1.00 _ PERMIT NO.
SEPTIC TT SEEPAGE PST OR —'w I--- -- Itii. --- -----�-- -�---�—__
_-- PITS AND/OR DRAINFIE_LD �/_'00 - - WASTE APPROVAL
CcSSP00L-DRY`WELL -
__ SPECIAL COA'DITIONS ONLY 2.00 — _ CHARGES
- '�— — CONNECTION CHARGE FEE
OWNER'S PERMIT__ _ � 1 00
AUTHORIZATION TOTAL PEE , REIMBURSEMENT FE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON.
TRACTOR 10 CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS si.c..►7 � DA;E INSPECTOR. S SIGNATURE
TO THE PUBLIC SEWER _—
SIGNED THIS_ —DAY OF NEW �ousE SEWER }
— --- _ !
.
OWNER OR
CONNECT ADDITIONAL
OWNERS AGENT_ ----
✓"� SEPTIC TANK,SEEP, PIT(S)
p,ND1OR_DR51_N_FIE_L-D
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL G DRYWELL 0
AND STATE THAT THE ABOVE 15 CI
AND AGREE TO COMPLY
WITH AI:L COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS, ALTER,REPAIR, SEWER OR - - -- -—
__SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AICD/CR SEWAGE
SYSTEM.
-
LSCENSED. AS REOT:IRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSES WEF _
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS V
SEEP PITS} E1 CES SPOOLS0
SIGNATURE -
OF PERMITTEE,
WILLIAM J.FOX.CoukTY ENGINEER VALIDATION R.A.WOOD. CHIEF PLEIG. INSPIECTOR
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