HomeMy Public PortalAbout6436 TEMPLE CITY BLVD_Sewer__ ( DEPA rl2lD&NT OF COUNTY ENG CIMM SEWER-,SEWAGE DISPOSAL 1
DMSION OF BUnMING AND SAFETY PERMIT APPLICATION
COIIINTY OF LOS ANGELES /' `
J WILLIAM J. FOX, COUNTY ENGINEER BUILDING /_ /�3 / ITelno/ U z /-
AODRE88 l!J^r" (D/Y / jYji' Q'
/FFOR APPLICANTTOFILL IN LOCALITY �jy) C/
ADORES (p ,3 1- � / F CROSS ST I� N �T
LOCALITY7;EryrdLt rTN DISTRICT NO SERIAL NO PERMIT NO
ROSS ST S '°'
C / 9 cl8 /2 tD 3 NEAREST S
_pp 1' (� RECEIVED BY Bowly IGF In"Is"on DATE ISSUED
OWNER LI.,CL- i ►�S O 3e.// 7- _ 3
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
_ BK PO
CITY E CrT TEL NO,Do (0/ 3 () /
CONTRACTOR Aldr C / ).1 ` D CO.Imp NO r�
ADDRE88 / � ,�d FN O C U
yy��yI JOB NO
CIiY aAai�/e:LTEL NO Ir G-7 1-1)� TRUNK PERMIT NO
REGISTRATION NO G �3 ❑ STATE
AUNTY ^
CC _ ROAD PERMIT NO �y Ip ,5`2.
DESCRIPTION LOT NO UD.b D 1 O Y 1 N Lpc Ic I STATE ENCROACHMENT
�` PERMIT NO
BLOCK TRACT„] INDUSTRIAL
D `/ Q NO OF BLOBS K WASTE APPROVAL
SIZE OF LOT NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTI ARGE FEE
NO DESO PTION OF WORK FEE
HOUSE SEWER CONNECTING TO _ REIMBURSEMENT FEE
PU -CSEWER ® i am 3 bD RECEIPT NO E BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
COIN T ADDITION- BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 MI
ATTER OR REPATR EXISTING NO DATE
SEWER OR DISPOSAL SYSTEM 100 -
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 ao CONNECTION DATA
SEPTIC TANK SEEPAGEPIY OR
P1T6 AND OR GRAINFIELD 200 STATION 2.374 DEPTH
E 00 ELL
SPECIAL CONDITIONS ONLY 200 MANHOLE REFEREM E I' /'
-41`14-1541- ��l' )4 LOWER
TYPE OF CONNECTIO LENGTH FROM
OWNERS PERMIT Y — CURB P L —M-L TO P L 25
AUTHORIZATION I TOTAL FEE SO
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THEA E DESCRI D EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TH PUBLIC SEW
SIGNED THIS�DAY OF 19 NEW HOUSE SEWER -/D-
OWNER OR C CONNECT ADDITIONAL
OWNERS AGENT _ _ ___ __ __ _ BUILDINOORWORK
ADDRESS __ _ SEPTICTANN SEEP PIT(S)
AND/OR DRAT NFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL I] DRYWELL❑
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY OROINAMCES 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
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF ALIFORNIA OR THEESSAIIT M THE LEGAL OWN
ER OF THE AB E NSCRI D R AL PROPERTY CKF LL SEP CTANK nn
URE
T BEEP PIT(g)0 CESSPOOL$0
OFPE
OF PERMITTEE _ �
BEGENNN'
y0AS/2D 00B 1/6