HomeMy Public PortalAbout6234-6236 TEMPLE CITY BLVD_Sewer__ T
a EasIt B! APPLICATION FOR PERMIT 1
DIVMON OF BUILDING AND SAFM SEWER-SEWAGE DISPOSAL
DepactneW of Counts' Engineer
Co" of Los Angelos BUILDSDDRElS �¢'--cp 151k,16
JOHN A LAMBIE COUNTY ENGINEER A (n/z /
m CASSATTD GRIFFIN SUFTDIBUILDINO LOCALITYNEAR
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FOR APPLICANT TO FILL IN CROS!BT
LEGAL OWNER
DESCRIPTION LOT NO
MAIL
BLOCK T� /RAACT�a/4�*14" Eu ���f�7/ ADDRESS /
SIZE OF LOT /{�(JJ NO OF 8LD68 I� Clry EL NO
NOW ON LOT J
USE DI DIST T NO ROUP YAP
OF
BUILDINGS
PG
CONTRACTOR
ADDRESS CONNECTION DATA
I �
CI TEL NO O.C.I STATION DEPTH
MANHOLE REFERENCE UPPED
,( tf STATE LOWER
REGISTRATION NO / (/ ❑ COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ S 3 SO Y CURB P L Y L TO P L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD ® 3 00
OVERFLOW SEEPAGE PIT,DRAIN FIELD P C NO
KT
EN CESSPOOL DRYWELL MANHOLE Z 00 CO IMF NO JOS NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® S 100 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR /� q STATE EN CROACHYENT
WON TO HOUSE SEWER @ $1
00 Q V PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION TO�TPSE S 1 00 REIMBURSEMENT FEE U n2 K}
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR 9SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EKISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED TH IS_ AAY OF 19_ CONNECT ADDITIONAL
OWNER OR ��/(� BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED By LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT THE LEGAL WRIER OF THE A YE
DESCRIBED PESIDENTIA PR ERN BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP PIT(S)❑ CESSPOOLS❑
OF PERMITTEE
JOHN A LAMBIE.COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
M2 5 1 0 ZR NOV `" `"a 2.0 0 tD
DEPAICTDIE 4T OF COUNTY ENGINEM SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUII.DING AND SAFETY PERMIT APPLICATION
OOUNW OF LOS ANGELES
WILLIAM J. FCX. COUNTY ENGINEER BUILDING L � * o /
ADILDIN LJ` d��.0' y
FOR APPLICANT TO INLOCALITY e;
BUILDING 'CREOSSSTT Go �OEN
ADDRESS
LOCALITY DISTRICT NO SERIAL NO PERMIT NO
NEAREST AsOs3 S
OHM ST
REQEIV p0Ad1'fW IOWOatlu DAT 186UE
OWNER / � r
ADDRESS Ip USE ZO OCCUPANCY7RP�'�J/
CITY TEL. 0 ��Z /��S BK PQ AG24
CONTRACTOR 3
-Co.imp NO
ADDRESS
/ JOB NO
CITY E 0
TRUNK PERMIT NO
STATE /
RE GT ATIOM NO COUNTY ROAD PFpNiT NO
LEGAL Z 65
DESCRIPTION LOT YO STATE ENCROACHMENT
PERMIT MO
BL TRACY INDUSTRIAL
WASTE APPROVAL
SIZE OF O SLO
OW Omil 0 T CXARGE8
BUILDINGOF O Z CONNECTION CHARGE FEE
_ NO DESCRIPTION Offf WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER ® { 330 156RECEIPT NOE BY
HOUSE SEWER CONNECTING
TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT AD ITIONAL 13LDS OR DO EXCEPTI p HOED
WORK TO HOUSE SEWER 100
ALTER ERREPAIREXISTINB MO DAT BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AMD/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTfCTANK 8 PPIT OR
PITS AND OR DRAINPIELD 2A0
CE 1^o YWELL STATION G a, DEPTH CUA
SPEGAL CONDITIONS ONLY 200 ,2 / MANHOLE REFERENCE OWE
TYPE C RENCTIOM LGTH FROM
OWNERS PERMIT f QD M L TO P L
AUTHORIZATION TOTAL FEEA4
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INBPECTOR•8818NATI1 E DATE
SIGNED THIS i{/..� AY OF 19NEW HOUSE SEWER
9,Ax s
OWNER OR CONNECT ADDITIONAL
OWNERS YEN � _ BUILDING OR WORK
ADDRE88_1/f�l. SEPTIDTANK BEEP PIT(S)
AND OR DRAINPIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGHEE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR,SEWEROR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED DI860NNE67 PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I A EGAL 0
ER OF THE ABOVE DE BED I AL PROPERTY SA K ILL SEPTIC TANKS n
SIGNATURE SEEP PIT(S)D CESSPOOL$ G
OF PERMITTEE _
73A642D O33 1153 n
DEYAIlITNOENT OF COUNTY ENGINEER, SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF L08 ANGELES
WILLIAM J. FOX. COUNTY ENGINEER 8UILDI NO ADDRE
FOR APPLICANT TO FIL IN, LOCALITY
BUILDIMB yy NEAREST
AODRf88 GROSS ST
LOCALITY DISTRI6T NO SERIAL NO PERMIT NO
NEAREST 5 A S
OR088 ST /
[ VE BY Remb,fef ISapwtM[ DATE ISSUED
NAIL 1 USE 201 OCCUPANCY �O dMAP `l
ADDREB6 ,p pK PO
CITY a TEL 0 "$ D D �1 - 2
CONTRACTOR 10
CO.IMP NO
ADDRESS
JOB MO
CITY TEL NO TRUNK PERMIT YO
STATE
REGISTRATION NO COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO STATE ENCROACHMENT
.71 r
PERMIT NO
BLOCK TRACT r4 INDUSTRIAL
SIZE OF LOT '/IS
(� /- NONOW OF ON BLOT {/LOCS 2 - WASTE APPROVAL
/f � lc' S�
CHAROEB
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER ® 8 860 RECEIPT NO DATE IBY
HOUSE SEW ER CON MECT NO TO
PRIVATE DISPOSAL SYSTEM 100 D
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER-0-il EEPAIR EXISTING _ NO DATE SY
SEWER OR DISPOSAL SYSTEM IfM _
DISCONNECT AND ABANDON SEWER
AMD OR DISPOSAL SYSTEM I00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAIMFIELD 200
ESSPO L—DRYWELL STATION DEPTH
SPECIAL C0NDITIONS ONLY 200 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT f I 00 Y CURB P L M L TO P L
AUTHORIZATION I TOTAL FEE 1 1- 10 ()
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR B SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER ` _
SIGNED THIS DAY _ 19,<3 NEW HOUSE SEWER
OVQ / CONNECT ADDITIONAL
BUILDING OR WORKO® YT
SEPTIC TA
ADDRESS 103 �p,1�Af� J AM/OR DRAIMFIELD IT(8)
1 HEREBY ACKNOWLEDGE THAT 11HAVE REID 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 DISPOLAL SYSTEM
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED
AND OR LICENSED AS REQUIRED BY LOB ANGELES COUNTY DISCONNECT PLUG AND
AMD STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOV& DEESSJCRIG y\RESIDENTIIA PROPERTY BA BEP 1 ANKS�I
SIGNATURE T K J_�f_)' . . ,. SEEP PIT(B)o CE88P00L$0
OF PERM ITT[E
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