HomeMy Public PortalAbout5923 BARTLETT AVE_Sewer__ DEPAIMUM4'T OF OOUNTY ENGII� SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS ANCRU
WILLIAM J. FOX, COLIHTY CiNOINE[R BUILDING
ABDDRE88 59 a
FOR APPLICANTO RLL IN LOCALITY
BUILDING NEAREST
ADDRESS OSOSi ST. e
LOCALITY DISTRICT NO. SERIAL M0. PERMIT NO. c
NEAREST
fiCEIVED BY Rraft for Iwpwico DATE ISSUED S
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CROSS ST. �� �►.� n 5_�JA L� � I�
OWNER An t- I a: 014 zq S oA
PAIL G y� O yF USE ZO OCCUPANCY BIC YAP pe
-ADDRESS ✓ /J /�
CITY TEL.NO. I/
OONTRAOTM4faM1, ! �eWer ConS'�rCUW CCI- CO.IMP.NO, \
ADDRESS /' mu Colegro," Aw. JOE.NO,
CITY MplItOW114, TEL &lif-Mli
TRUNK PERMIT N0.
STATE
REGISTRATION N0. ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT M0. PERMIT NO. �~
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT A M 6 NO-OF BLOTS
OW ON LOT CHARGES
USE OF CONNECTIO [FEfi
BUILDING8
No. DEBCRIPTION OF WORK F[E
REIMBURSEMENT FEE
HOUSE SEWER GONNEOTIMI TO
PUBLIC SEWER Lu RECEIPT NO. D BY
HOUSE SEWER OONNeIWING TO
PRIVATE DISPOSAL SYSTEM L"
OONNtCT ADDMONAL BL G.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER I W M0.
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM IJMI
DISCONNECT AND ABAN OM SEWER
AND OR DISPOSAL SYSTEM I.011 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFI[LD 2AG STATION + DEPTH
CESSPOOL LL
SPECIAL CONDITIONS ONLY !NSO Pp FEHENC[
TYPEF 60JiN CTIOLENGTH FROM /
OUR M.L TO P.L.
OWNERS PEAMrr ; I 00
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRAOTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED T I Y 195 MEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TAMKK,BEEP.PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE BEAD THIS APPLI- CESSPOOL E] DRYW[LL❑
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR S[WER OR
RHGULATING PLUMBING AND SEWER& SEWAGE DISPOISAL SYST[M
I HEREBY CERTIFY THAT 1 AM PROPKRLY REGISTERED DISCONNECT PLUG AND
AND/OR LIOfiNSED AS REQ RED BY LOG ANGELES COUNTY ABANDON TPLUG AND
AND STATE OF CALIF NI R THAT I AM THE LEGAL OWN-
ER OF THE ABO ESIDENTIAL PROPS TAM ��]]
BEEP.PIT(S)E] CESSPOOL a
81GNATV RE
OF PERMITTEE
T6A&0A ERb T/U
COLKTT OF LOS ANGELES :, TEMPLE CITY — . 0 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TL A8 SE 0508 0112120011
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 .
PHONE:. (626) 285-0488., EXT:
LEGAL ID: SEWER Y BUILDING ADDRESS:.
TR: 5903 LT: 95 EXIST OCC GRP:•. 5923 BARTLETT AV�
BLDGS. MOW Olt LOT: - SCAB CA 917752609
CONNECTION TYPE: NEAREST CROSS STREEt:'-HER1408A
5386-014-045 ORIGINATION THOMAS PAGE: 596 GRID: G3 -LOCALXTY: TEMPLE C.1 TY
LENGTH NL TO.PL: STATION.-_ DEPTH:
HOLE REFER"CE: UPPER/LOWER: -ISSM Old: PROCESSED BY: EXPIRES
12/12/01 JK. 06/10/02 '
COUNTY IMtPROVEMENT NUMBER:-(AMER :
LIME,•DANANT PLAN CHECK NUMBER: FINAL DATE OWE:
(626) 285x5222— UMP
JOB MER: 9/
(
5722 BUUTOB AVE. TRUNK PERMIT NUMBER: '
TEMPLE CITY 91708 ROAD PERMIT NURSER: i S
AFFADAVITNO - . SEWER FOR NEW SFR
IVER: .:. NO
EASEMENT: . NO
ARC DESIGN i ARCHITECT (ALEX NA) (626) 308-3697-
1227 W VALLEY BL#109 RECORD INSTRUMIENT MBR: RECORD DATE: SPECIAL CONDITIONS:
. ALHAMBRA CA 91803 HIGHUAY/ETRE I
STATE Eli W E$
TEL. NO: DAlh INSPECTOR,SIGKATLJRE'.
THIRD MILLENIUMI CONSTRUCTION, INC. (626) 284-6679- ���``0
1227 �F VALLEY,BLVD. #115 LIC. NO F ESCRi ON: QUANTITY: L AMOUNT:
ALHAMBRA- CA 91803 750128 B
P T I F \ �� 27.75 CONNECT ADDITIONAL
N LIC 00 COM 46.95- BUILDING OR WORK
ARtHITECT TEL. NO: L FtES \ 74.70
ARC DE8IGlt AND ARCHITECTURE . (626) 308-3697- -SEPTIC TANK SEMUFM
1227 W•VALLEY BLVD #109 LIC. NO t AND/OR DRAI�i FIELD
ALHAMBRA CA.91803
NONE �'_' ' 11
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DRYML
US
1l��,Q .. . W v LI U ALTER REPAIR
SELMLGk DI8POS�UL $YSTElI
MUNWECT PLUG AND
ABANDON HOUSE•SEWER'
r t SEEP. PIT _ CESSPOOL _
0.
t
Service ' ha
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- REPORT, ID:,-DPR266 ROME M BS0508 _ } -