Loading...
HomeMy Public PortalAbout6430 TEMPLE CITY BLVD_Sewer__ APPLICATION FOR PERMIT 1 •�ceaa DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Dep�aenfCounty of County Engineer of Los Angel" BD ILDIND WM J FOX. COUNTY ENGINwA ADDRESS CAASATT D GRIFFIN,6W T or SYILDINa LOCALITY FOR APPLICANT TO M IN ctoa�ar LEGAL DESCRIPTION LOT No OWNER BLOC[ TRACT NAIL ADO ESS .��.Y no of eLDGa SIZE OF LOT /�+� NOW ON LOT CITY TEL p0 U!E OF BUILDINGS DISTRICT NO I GROUP I NAP CONTRACTOR � �. T/r_ OR PO ADDRESS SCONNECTION DATA CITY XO STATI DEPTH REGISTRATION NO y y 7 6 C yQ COUNTY YA UPPER REFERENCE LOWER TYPECONNECTION LENGTH FRO No DESCRIPTION OF WORK FEE T C e p L M L TO p HOUSE SEWR'PUSL C SEWERCONNECTING TO ® 7 a SO _ HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1 00 __ CONNECT ADDITIONAL BLDG OR r� CO IMF NO NO WORK TO HOUSE SEWER 100 ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD P IT NO DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT 'ND/OR DISPOSAL SYSTEM f 00 PERMIT NO SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR GRAINFIELD Z 00 INDUSTRIAL CESSPOOL- DRYWELL -- WASTE APPROVAL SPECIAL CONDITIONS ONLY Z 00 CHARGES CONNECTIO CHARGE FEE (� Ovfta$w'ws pEpJw S 1 00 1-1 AUTHORtUTION TOTAL. IEE N REIMBURSEMENT FEEI HAVE DATE CO ON TRACTORTHIS TO CONNECT THEAABOVE DESCRBEDWITTHEx EREIN EXISTINGA MED DWELLING APPROVALS DATE INSPECTORS SIGMA URE TO THE PUBLIC�SK ER SIGNED THISI�DAY O ��- ig-fj-F-6- NEW rouse SEWER a¢" OWNER OR CONNECT D ADDITIONAL OWNER! AGENT .f.L1�.4�•�1 COWORK SEPTIC TANK SEEP, PIT($) ADDRE54 ARD/OR DRAIRFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DAYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAW[ REGULATING ALTER, REPAIR SEWER OR PLUMBING AND SEWERS SEWAGE EPAIR A EWER OR LICEM1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR SEWAGE EC DISPOSAL AND ENSED At REOUIRED BY LOS ANGELES COUNTY AND STATE OF PLUG CALIFORNIA OR THAT 1 AN T e LEGAL OWNER OF THE ASOVK ABANDON HOUSE SEWER DESCRIBED RE910fiNT1 Of Y BACKFILL BE C TAN[1❑ SEEP PIT R CE7 LS SIGNATURE OF PERMITTEe WILLIAM J.FOX.COUNTY 01INsim VALIDATION jr43 17 3S; APR28 4 2.0 0 0 By BY DEPUTY DEPUTY BY EY m DEPUTY 1 _ Jp! DEPUTY