HomeMy Public PortalAbout5140 BALDWIN AVE_Sewer__ (2) CE8082888 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ABUILDING
DDRESS/
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. i
LEGAL / �f `
DESCRIPTION LOT NO. - OWNER C
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT ti CITY TEL.N0.
USE OF r
BUILDINGS j - DISTRICT N0. GROUP MAP PROCESSED BY
CONTRACTOR
ADDRESS �� Gg CONNECTION DATA
CITY ,� j'• �_ TEL.N0. -STATION &f '3 DEPTH STATE
MANHOLE REFERENCE
COUNTY a �ER
REGISTRATION N0. /(C-_�i�'d1 8 rar LOWER
NO. DESCRIPTION OF WORK FEE
/ HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 % G-: -
SEPTIC TANK, SEEPAGE PIT OR TYPE OF C04KCTION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L* M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. N0. JOB N0.
CONNECT ADDITIONAL BLDG 7 TRUNK PERMIT NO. C C
/ WORK TO HOUSE SEWER �' i.@ $1.00 1 `2c�ROAD PERMIT N0.( - /[rJ(7 J J
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 _PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
_ CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE c /y " gEIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS "'DATE INSPECTO 'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS L_i SAY OF 19 _NEW HOUSE SEWER< "£
OWNER ORCONNECT A2PITTONAL
OWNERS AGENT ✓j. - j _BUILDINrot R WORK -
rj ' �' SEPTIC TANK,SEEP,PITS)
ADDRESS _! `AND/OR DRAINFIEi_Z
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICAT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMP YY _CESSPOO •',DR1WEIL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATt LTE '.RA g4EVYEROR 1_� '
PLUMBING AND SEWERS. . _ WJkG I YfAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DI$ p CT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF AB DON HOUSE SE
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI L PROPERTY, SEEPFI L SEPjAe1A
CENKS
SSPOOLS❑ L) NCIH d�71®
SIGNATURE /
OF PERMITTEIlk
OF ALMATION ROBERT A.WOOD
SUPERVISING MECHANICAL ENGINEER
�; �,,
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS ( SE 0508 1109150007
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285 0488 EXT
LEGAL ID ISEWER / SEPTIC SEWER BUILDING ADDRESS
I ON FILE IEXIST OCC GRP I 5140 BALDWIN AV 1
I IBLDGS NOW ON LOT TEMP CA 917803901 1
(ASSESSOR INFORMATION NUMBER ICONNECTION TYPE NEAREST CROSS STREET 1
18585 007 039 (ORIGINATION 1 THOMAS PAGE 597 GRID B4 LOCALITY TEMPLE CITY CAI
I ILENGTH ML TO PL STATION DEPTH
ITENANT IMANHOLE REFERENCE UPPER/LOWER (ISSUED ON PROCESSED BY 1
I 1 109/15/11 SR I
I (COUNTY IMPROVEMENT NUMBER I I
TOWNER TEL NO IIPLAN CHECK JOB NUMBER NUMBER IFINAL DATE FIN BY CODE
MUNOZ STELLA �
15140 BALDWIN AV (TRUNK PERMIT NUMBER I
ITEMP 917803901 ROAD PERMIT NUMBER 1DE�CRIPTIOI OF WORK
IAFFADAVIT NO ISEAER REPAIR 1
1 (WAIVER NO 1 I
(APPLICANT TEL NO 1EASEMENT NO I 1
IRUDYS PLUMBING (626) 358 1490 1
IPO BOX 407 IRECORD INSTRUMENT NBR RECORD DATE ISPECIAL CONDITIONS 1
IHIGHWAY/STREET WIDENING
ISTATE ENCROACHMENT PERMIT NUMBER
ICONTRACTOR TEL NO I FEES PAID IAPPROVALSJ DATE INSPECTOR SIGNATURE
IRUDY S PLUMBING (626) 358 1490 1 1 1
IP 0 BOX 407 LIC NO IFEE DESCRIPTION QUANTITY UOM AMOUNT INEW HOUSE SEWER I I I
(MONROVIA CA 91016 917340 1 1_ I
1 101 PERMIT ISSUANCE FEE 27 80 ICONNECT ADDITIONAL I I 1
1 115 ALT/REP HOUSE SEWER 1 00 EAC 30 40 IBUILDING OR WORK
1ARCHITECT OR ENGINEER TEL NO I TOTAL FEES 58 20 1 1 1
IISEPTIC TANK SEEPAGE PITI I I
LIC NO +1 IAND/OR DRAIN FIELD I 1 1
I IDRYWELL _ I 1
I I_L 11
SEWER MAP BOOK PAGE I i IALTER REPAIR SEWER OR
I (SEWAGE DISPOSAL SYSTEM I 1
1 I IDIS^_ONNECT PLUG AND I 1
I (ABANDON HOUSE SEWER
I I I I I I
1 IBACKFILL SEPTIC TANKS _ 1
ISEED PIT _ CESSPOOL _1
I I I I I I
1 IGRAYWATER SYSTEM 1 1 1
I I I 1I _II I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
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IREPORT ID DPR266 ROUTE TO BS0508
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