HomeMy Public PortalAbout6415 TEMPLE CITY BLVD_Sewer__ i
DEPAftTMF1HT OF COUNTY eNOINffit SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGFJ.EB
WILLIAM J. FOX, COUNTY ENGINEER BU ILDINOE88 I_.
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R P CANT TO LL IN LOCALITY
BUILDING NEAREST
AD CROSS BT OIL
LOCALITY DISTRICT NO SERIAL N -PERMIT NO
NEAREST V A 9 D 7 ) 6 5
CROSS BT
RE EIV
ED BY R.Ab fv IO3pnooO DATEISSUED
OWNER
NAILADDUSE ZONE OCCUPANCY -4NAP`
CITY 8 BK_ PB
0m L R/ pK
OONTRACTO CO.INP NO
ADDRESS
JOB.MO
CITY TEL NO14 7X 70V a TRUNK PERMIT MOSTA -^
REGISTRATION COUNTY �l 7 / 6737 �7
p ROAD PERMIT q0 7. / v
DESCRILEGAPTION LOT NO - O I STATE
NCROACHMENT�7
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
812E OF LOT O NO 0I BLOBS
NOW ON LOT CHARGES
USE OF
BUILDINGS - CONNECTION CHARGE FEE
NO SEWER
rO M OF RK FEE REIMBURBEMENT FEE
HOUSE SEWER CONNEC O
PU$LICSEWER ® B 360 W S� RECEIPT NO I DV IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
-6ONNECT A ITI NAL BLOO OR EXCEPTION DED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING _ NO DATE BY
SEWER OR DISPOSAL SYSTEM 100
ANO/ORNUISPOSAL SBY/(STEINN SEWER 100 CONNECTION DATA
SEPTIC TAN K.SEEPAGE PIT OR ^
PITS AMO OR GRAINFIELD 2.00 STATION DC / DEPTH
CESSPOOL-DRY W ELL
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENCE
-_LPPEIt- LOWER
TYPEOF CONNECTION LENGTH FROM
CURB -ZJ- N L TO P L
OWNERS PERMIT $ I 00 11
AUTHORIZATION Al E$t
TOTAL FEE -
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 $EWE
SIGNED THIS DAY OF 19 NEW HOUSE SEWER
OWNER OR _ CONNECT ADDITIONAL
OWNERS A E BUILDING D WORK
BEPTID TANK SEEP PIT(8)
ADDREB AND/OR GRAINFIELD
1 HERE KNOWLEDGE TXAT IAVE READ THIS APPLI- CESSPOOL DRYWELL❑
CATION A STATE THAT THE ABOYENS CORRECT AND AGREE'
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS' ALTER.REPAIR SEWER OR
REGULATING PLUMBING ANDSEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOB ANGELES COUNTY DISCONNECT PLUS AND
AMD STATE OF CALIFORNIA OR THAT IN THE LEGAL WN- ABANDON HOUSE SEWER
ER OF THE ABOVE D RI BED D IAL PROPER BACKFILL SEPTIC TANKS I�
SIGNATURE �nL E�j/)iyie BEEP PIT(S)0 CESSPOOLS
OF PERMITTE ♦�
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