HomeMy Public PortalAbout4913 ARDEN DR_Sewer__ E808.D
CAPPLICATION. FOR PERMIT
E808.8-58 COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER ®'��®���
BUILDING AND SAFETY DIVISION 4[A7DDRESS
JOHN A. LAMBIE, County Engineer m A D
CASSAIT D. GRIFFIN, Sup't of Building Temble City
:.FOR APPLICANT TO FILL: IN Lower Azusa
LEGAL
–DESCRIPTION LOT NO. 10 OWNER Winberg
BLOCK TRACT 11 1a PS ADDRESS 01 N. 2nd St .
NO.OF BLDGS. - p
SIZE OF LOT NOW ON LOT CITYA b a TEL.NO.
USE OF ..,..,..
BUILDINGS 3 Res. DISTRICT NO. GROUP MAPPG PROCESSED BY
CONTRACTOR square Deal Sewer Service
e
ADDRESS 2933 Maxs o n Rd. CONNECTION DATA
CITY . El Monte TEL.NO.CTI 4-2020 STATION -Y---Sl(, DEPTH
$] STATE MANHOLEREFERENCE
REGISTRATION NO. C-42 128870 ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
Z PUBLIC SEWER @ $3.00 3100 TYPE NN jION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CUR P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00 -
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. DL JOB NO.
3 CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
SEWER OR DISPOSAL SYSTEM ALTER, REPAIR OR ABANDON
HOUSE @ $1.00 STATE ENCROACH N
PERMIT N0.
INDUSTRIAL rP
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 7 . 00 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DTE INSP GNATU
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF l9, NEW HOUSE SEWER
OWNER OR �— `" CONNECT ADDITIONAL
OWNERS AGENT '�4 /&,,4,,f4;' _ / BUILDING OR WORK
ADDRESS �4 4 Al, - / ,:Z l�.G'', SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL[:I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS']/ SEEP.PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
®R VALIDATION ROBERT A.WOOD
CK. N.O. CASH SUPERVISING MECHANICAL ENGINEER
1 i.,o f3 2 1 ,Jus' 24 5 Ft
TO U
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1211140011
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: ISEWER / SEPTIC: SEWER BUILDING ADDRESS: 1
-ITR: 11148 LT: 10 BL: A IEXIST OCC GRP: 4913 ARDEN DR
I IBLDGS. NOW ON LOT: TEMP CA 917804048 1
(ASSESSOR INFORMATION NUMBER: ICONNECTION TYPE: NEAREST CROSS STREET: LOWER AZUSA 1
18585-015-013 (ORIGINATION: THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, Cl
I ILENGTH ML TO PL: STATION: DEPTH:
(TENANT: IMANHOLE REFERENCE: UPPER/LOWER: 11SSUED ON: PROCESSED BY:
1 1 111/14/12 SR 1
1 (COUNTY IMPROVEMENT NUMBER: I 1
(OWNER: TEL. NO: IPLAN CHECK NUMBER: IFINALDATE FI BY: CODE: I
IHO, GRACE (626) 890-3166- IJOB NUMBER: I
14913 ARDEN DRIVE. ITRUNK PERMIT NUMBER: I �'�/gyp r I
ITEMPLE.CITY CA 91780 I,ROAD PERMIT NUMBER: (DESCRIPTION OF WORK I
IAFFADAVIT: NO IREPAIR SEWER LINE
1 (WAIVER: NO I 1
(APPLICANT: TEL. NO: 1EASEMENT: NO I
1U, WA KUOK (626) 628-4386 1 1 1
12609 GAGE AVE. IRECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS: 1
1EL MONTE CA 91733 IHIGHWAY/STREET WIDENING: I 1
ISTATE ENCROACHMENT PERMIT NUMBER: 1
I I I I
ICONTRACTOR: TEL. NO: I FEES PAID 1APPROVALS DATE INSPECTOR SIGNATURE
WAKUOK U (626) 688-43867 1 1
12609 GAGE AVE LIC. NO IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: INEW HOUSE SEWER I 1 1
1EL MONTE CA 91733 863280-B * I I I 1 1
1 101 PERMIT ISSUANCE FEE 27.80 ICONNECT ADDITIONAL
1 103 CONN TO PUBLIC SEWER 1.00 CON 47.00 (BUILDING OR WORK
1ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 74.80 1 1
I - I ISEPTIC TANK, SEEPAGE PITI I 1
I LIC. NO: I (AND/OR DRAIN FIELD I 1 1
1 1 IDRYWELL
I I I I I
1 SEWER MAP BOOK: PAGE: 1 (ALTER, REPAIR, SEWER OR I
1 1 ISEWAGE DISPOSAL SYSTEM
I I I I I I
1 1 1DISCONNECT PLUG AND 1 1 1
1 1 1ABANDON HOUSE SEWER 1 1 1
I I I I I I
I I IBACKFILL SEPTIC TANKS
I (SEEP. PIT _ CESSPOOL
I I I I I I
I 1GRAYWATER SYSTEM 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
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 I I I I I
1 1* ADDITIONAL DATA ON FILE I 1 1
I I I I I I
1 IREPORT ID: DPR266 ROUTE TO BS0508 1 1 1 1
I I I I I I