HomeMy Public PortalAbout6424 TEMPLE CITY BLVD_Sewer__ DEPARTSIENT OF COTJNW ENGINEES SEWER-SEWAGE DISPOSAL 1
DIVISIQN OF BUILDLNG AND SAFEW PERMIT APPLICATION
OOUNW OF LOS ANGELES L, qq •/ yyII
WILLIAM J. PDX. COUNTY ENDIN[[R I AO�RE88 6 7 •r�, Y/✓ 1TFA///-'�� C J•/''I
J
FOR APPLICAN TO FILL I 1 LOCALITY
BUILDING II NEAREST
ADDflE3S CR0888T
LOCALIT / DISTRACT NO SERIAL NO PERMIT NO
NEAREST �� A R 7 0 3 y S
_BOSS ST AL AFA4 A A(
ECEIVED BY Ready for lospedlo0 DATE ISSUED
OWNER �I SAY
MAIL
USE20NE OCCUPANCY BK MAP PS
ADDRESS
CITYTEL MD /r —/ /= s �"� - ,�7
CONTRACTOR D W ME? CO IMP NO j ;, 7 7 -
ADDRESS S/y/Li C— JOB NO
CITY TEL NO TRUNK PERMIT NO
eCOUNTY ROAD PERMIT NO � 7 G �4
REGISTRATION NO ff
LEGAL STATE ENCROACHMENT
DESCRIPTIO,/N LOT NO /� PERMIT NO —
BLOCK / TRACT sAd iA L/ �� � DUSTRIAL APPROVAL !
812E OF LOTOG
.3-n X S&.O NOW ONN LOTS
Z CHARGES
USE OF
SUI LDINGB A jr geif— 4- B/t! CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
REIMBURSEMENT PEE
HOUSE SEWER CONNECTING TO
PUBLIOSEWER ® 11 3.60 Iro RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNEffA-DDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100
ALTER OR REPAIN EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT
OICBN ISPOBAL SYASTEMM SEWER IDO CONNECTION DATA
AAN , EEPABE PI 9,-7
J R L
PITS AND/OR DRAT NFIELD 200 STATION 2A /- y DCPTH
SPECICESSALC MONO DITIOMB ONLY 2000/. / [HOLE REFERENCE
! IJ M UPPER
TYPE OF CONN E TION' LENGTH FROM
OWNERS PERMIT ; 00 Y CURB 5/ P L ML TOPI.
AUTHORIZATION TOTAL FEE 610
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
OWNER OR OO NNECT ADDITIONAL
OWNERS AGENT __ _ _._ .- _ _ _ BUILDINOOR,,WORK
ADDRESS _ ___ _ _ _ _ _ _ _ _ _ _- _ ACPT'OTANKKND/OR DRAIMFIELEE D IT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWEROR
REGULATING PLUMBING AND SEWERS SEWAGE DISP067AL SYSTEM
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCON ECT PLUUSE G
AMD STATE OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN-
ER OF THE ABOVE Dfi IBED RESIDENTIAL PROPERTY F SEP ANK ��''II
SIGNATURE �- BEEP PR(8)� Cl88PoOLS 1 ��AAlfi fl� S'IO'
OF PERMITT[ -a—
T6A6/2A 062 4/630