HomeMy Public PortalAbout6345 TEMPLE CITY BLVD_Sewer__ DEPABTBEENT OF OOUNTY EN(11KEEB SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUn.DING AND SAFETY PERMIT APPLICATION
' COUNTY OF LOB ANOEI.P73
• 1 WILLIAM J. FOX, COu NTY ENGINEER I BUILDING
BUILDIADDRESS
AP LICeETO FlI�.L LOCALITY
BUILDING �i / NEAREST
ADDRESS ) 316w CROSS ST
LOCALITY DISTRICT NO SERIAL NO P/ `"/1 ERMIT NO
CR088ST S� 15-- 60
CO A – S
p RECEIVED BY Reaft/n 106Faa l n DATE ISS ED
OWNER ,y / / /
AODRE88 V !Lir•� e / USEZONE OOCUFA OY MAP
BK PO
CITY �� TEL.NO --
CONTRACTOR /d
00 IMP NO
ADDRESS 170el
NO
JO
''11 { / B.
CITY G' JTy TEL NO TRUNK PERMIT MO
REGISTRATION NO { J,r%D� B COUNTpY ROAD PERMIT NO
DESCRIPTION LOT NO 21 O �r9 7�/G PERMIT NO ROACHMENT
BLOCK TRACT/i/,7/sJl INDUSTRIAL
y WASTE APPROVAL
SIZE OF LOT �Jjl �� NO
ON LO SA CHAROES
USE
CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FE REIMBURSEMENT FEE
HOUSE SEWER OONNEC INS
PUBLIC SEWER O i 660 T RECEIPT NO DATE By
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONN ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00 NO OATH BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND SEWER
AND/ORDISPOSAL EM1 00 CONNECTION DATA
SEPTIC TANK SEEPAGE OR -
PITS AMD/OR GRAINFIELD 200 STATION Z DEPTH
CESSPOOL--0RYW ELL
SPECIAL CONDITIONS ONLY 200 /y.MANHO�TEFEREMCEy , .,,./ LOWER
Y TYPE OFRPR CONNECTION yEL TONP D!Ft
OWNERS PERMIT { 1 00
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREI NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
Y �J NEW HOUSE SEWER J
SIGNED THIS �'_ Y OF _ _IV—OWNER OR CONNECT ADDITIONAL
OWNERS AO BUILDINGORWORK
JJ'' ��'' SEPTIC TANK,SEEP.PIT(S)
ADDRESS I— _ �J?Sl�_ AND/OR GRAINFIELD
1 HEREBY ACKNOWLED [ THAT 1 HA HEAD THIS APPLI- CESSPOOL Q DRYW[LL
CATION AND STATE THAT THE ABOVE IB 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 1 AN PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOB ANGELES COUNTY ABANDONHOUS[SAND
AND STAT[ OF CALIFORNIA OR TH AY HE LEGAL OWN-
ER OF THE ABOVE MEED EYTI PROPE11,111 BACKPILL 10 TAMK I"'I
I.eEEPPIT(S)� CE8SPOOL$
SIGNATURE
OF PERMITTEE 11,4
76A"ID 60 1/06 '