HomeMy Public PortalAbout6240 TEMPLE CITY BLVD_Sewer__ DEPAILffiIlT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DMSION OF 33UnM NG AND SAFETY PERMIT APPLIC ION
.i COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER BUILDING
ADDRESS
R APPL'Ir{^�ajO IN LOCALITY Mn
BUILDING •f LSO ryO / /� /' Q� _e
ADOflEBS IG T , I!! P�7 �CJ I4� /./�V((, OB088 ST /1 v01 /
LOCALITY e L C� DISTRICT NO SERIAL NO PERMIT NO ��
CNEROAss ar �u G y•e., . J A ��aAT ISS 5
f7 P Cc�LC�N s NECEIVEDBY Re�forlNNNaflw DAT ISSUED
OWNER
ADDRESS '0-- - VON OCCUPANCY YAP
SK
CITY
CONTRACTOR
CO IMP NO
ADDRESS
� JOB NO '•�
CITY L
THUNK PERMIT NO
STATE y
RE818TRAT1 N NO 'Ole
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ROAD PERMIT NO
DE$CHIP I N LOT O • �C V STATE ENCROACHMENT
PERMIT NO
BLOCK JRACr jilaph,AlkAgl 6D INDUSTRIAL
81%21 %v OF BLDOB WASTE APPROVAL
T NOW ON LOT CHARGES
U '
BUILDINGS 60NNE6T CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOREIMBURSEMENT F
PUBLIOSEWER ® 8 0.60 re) RECEIPT NO T6 BY
HOUB�EWEROONNECTIN TO
PRIVATE DISPOSAL SYSTEM 100
OONNECT ADDITIONAL BLOO OR EXCEPTION RECOpDED
WORK TO HOUSE SEWER 100 OG
ALTS OR REPAIBEXISTIN RU DAT! BY
$EWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA
SEPTIC AM PA PIT Ofl '
PITS AND/OR DRAINFIELD 2.00 kSTATIO DEPTH 6
POOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE
L OW
TYPE OFCONNECTION LENGTH FRON
OWNERS PERMIT s 00 CURB N L TOP L
AUTHORIZATION I TOTAL FEE A-r
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE EB RIBED EXISTING APPROVALS INSPECTOWS SIGNATURE DATE
DWELLING TO THE P BLIC SEWER I�^^
SIGNED THIS DAY OF _.._ _ 19a'? NEW HOUSE SEWER -
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ [_/ _ BUI LOINS OR WORK
ADDRESS 6,� O/pD SEPTICTANK BEEP PIT(S)
AND OR 0RAI NFIELI)
I HEREBY ACKNOWLEDGE THAT 1 RAVE 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,RE PAIRR,,SEWER OR
REGULATING PLUMBING AND SEWERS 8EWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED
AND LICENSED A8 flEQU1RED BY LOS ANBELEB COUNTY DISCONNECT PLUG AND
ANO STATE OF CALIFORNIA OR THAT I AM THE LEGAL WN- ABANDON HOUSE SEWER
ER OF THE ABOVEklBE, RIAL PROP SACKF EP 1 TANKSI1��
SEEP PIT(8)[] CESSPOOalz
SIGNATURE i
OF PERNITTF
76ASUD 668 1/6[