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HomeMy Public PortalAbout6121 TEMPLE CITY BLVD_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS L ��( l�►G� K FOR APPLICANT TO FILL IN LOCALITY BUILDING / ADDRESS Gf/ NEAREST y� CROSS ST.;y- y 1 '+ LOCALITY / ! DISTRICT NO. SERIAL NO. / PERMIT NO. NEAREST , J .- 6'� A f7"lJ©s� S CROSS ST. RECEIVED BY Ready for Inspection DATEISSUED OWNER �� j L _ L"f/L• 5-.6 MAIL USEZONE OCCUPANCY MAP ADDRESS , BK PG CITY JPL. I0 ADDRESS JOB.NO. CITY -j7 / „ TEL.NO / 7 frmeg_ — TRUNK PERMIT NO. STATE REGISTRATION NO. COUNTY ROAD PERMIT NO, LEGALSTATE ENCROACHMENT DESCRIPTION LOT N0.� �a1 PERMIT NO. BLOCK /Vj TRACT [� INDUSTRIAL WASTE APPROVAL SIZE OF LOT / N0.OF BLDGS. Lia NOW ON LOT 01 CHARGES USE OF BUILDINGS e._ _ CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO _PUBLIC SEWER @ $ 3.50 RECEIPT NO. ( DATE I BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM I.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 NG. DATE I BY ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR __FITS AND/OR DRAINFIELD 2.00 STATIONDEPTH CESSPOOL—DRYWELL -- SPECIAL CONDITIONS ONLY 2.00 MANIHOLERREFERENCE LONER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT ; 1 00 Y. CURB P.L. M.L.TO P.L. AUTHORIZATION I TOTAL FEE 1 '2 t^, — 1 HAVE THIS 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...._......_ 19........ NEW HOUSE SEWER t CONNECT ADDITIONAL OWNER OR OWNERS AGENT..........._..........................-_---...-•----.......----.._._._....... BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS...........____.................---------_------»_-I. -.-..--------. AND/ORDRAINFIELD ! HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL 0 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 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SIGNATURE ,, SEEP.PIT(S)to CESSPOOLS - F PERMITTE&c'-'--.,0�;, -..�------ ------------- OL i6A642D 663 1/53 DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING - .. ADDRESS FOR APPLICANT TO FILL IN LOCALITY BUILDING NEAREST ADDRESS _TGROSS ST. LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. cc i NEAREST A S CROSS T. RECEIVED BY Ready for Inspection DATE ISSUED OWNER MAIL ADDRESS _ USE ZONE OCCUPANCY BK MAP PG CITY TEL.NO. CONTRACTOR -- CO.IMP.N0. ADDRESS JOB.NO. CITY TEL.NO. TRUNK PERMIT N0. STATE REGISTRATION NO. COUNTY ROAD PERMIT NO. LEGAL V DESCRIPTION LOT NO. STATE ENCROACHMENT —� -- PERMIT NO. - BLOCK TRACT INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO.OF BLDGS. , NOW ON LOT CHARGES USE OF BUILDINGS CONNECTION CHARGE FEE -- NO. NO. DESCRIP'T'ION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO PUBLICSEWER @ $ 3.50 RECEIPT NO. DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR I EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 I NO. DATE I BY ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM_ 1.00 I DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA (SEime TANK.SEEPAGE PIT OR PITS AND/OR ORA€NFIELD 2.00 STATION DEPTH BESSPOOL—ORYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE ( UPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS PERMIT # � I 00 Y. CURB P.L. M.L.TO P.L. � AUTHORIZATION TOTAL FEE I I HAVE THIS 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 OR. __I9..___.. NEW HOUSE SEWER __._. — OWNER OR CONNECT ADDITIONAL OWNERS AGENT.............-.:.-----------.............__...._---------......---- BUILDING OR WORK ADDRESS.-----.......------------....... -------:.........:.........._-----_-._....-.__----.. SEPTIC TANK,SEEP.PIT(S)AND/OR DRAINFIELD 1 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 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(� SIGNATURE SEEP.PIT(S)❑ CESSPOOLS❑ OF PERMITTEE---- '-------- -------------------` -...._..... - - �^ 56A61.2D 663 1/53