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Home My Public Portal About9210 BLACKLEY ST_Sewer__ It, v¢,-� 76A 4i2D - CE808 - 9/73 APPLICATION FOR PERMIT . COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL.- DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS / LOCALITY NEAREST FOR APPLICANT TO FILL IN ROSS ST Awr LEGAL DESCRIPTION LOT NO -2j OWNER f 7 MAIL BLOCK TRACT M S /os ADDRESS ` NO OF BLDG SIZE OF LOT NOW ON LOT CITY TEL O USE OF BUILDINGS DISTRICT NO GROUP BK P3 MAP PRO) SSED BY .t CONTRACTOR e �L fJ�u M / _ �� /O 7 ADDRESS �. } CONNECTION DAT 'CITYNO- -- - - _ STATION- ._<< _ _ _DEPTH STATE LIC MANHOLE REFERENCE UPPER LICENSE NO CLASS LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM 1 HOUSE SEWER CONNECTING TO Y CURB P L ML TOP L ( PUBLIC SEWER �• C NO SEPTIC TANK SEEPAGE PIT OR J PITS AND/OR DRAINFIELD --_ CO IMP NO OB NO HOUSE SEWER CONNECTING TO - TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM CONNECT ADDITIONAL Alsaxp. 0 Li AFFIDAVIT I WAIVER I EASEMENT RECORD INSTR NO DATE WORK.ZO HOUSE SEWER OVERFLOW SEEPAGE PIT DRAINFIELD C) EXTN CESSPOOL DRYWELL V ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING � SEWER OR DISPOSAL SYSTEM@ O STATE ENCROACHMENT 1-� MANHOLE PERMIT NO W INDUSTRIAL d WASTE APPROVAL N CHARGES OWNER'S PERMIT s CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE _ TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE SIGNED THIS DAY OF 197--7 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL IV ADDRESS BUILDING OR WORK SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING , PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE D ISPOSAL SYSTEM CA�IFCFNIA OR THAT AM THE LEGAL OWNER OF,�Afip INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABO EI DESCRIBED RE ENTI PR RF ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TA 5 ❑ OF PEGtMTTTEE ❑ SEEP PIT(S) ❑ 5 DOLS VALIDATION CK M O CASH 4591_-APR, 1 9.00 •x: TEMPLE CITY 76A 642D -CE808-10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEAREEST 21 0 E. Blackley St. m E (1 Temple City FOR APPLICANT TO FILL IN ncinita y� DESAI CRIPTION LOT NO OWNER Milton Bade MAIL BLOCK TRACT ADDRESS 20 Birchcroft O OF BLDGS SIZE OF LOT NOW ON LOT CITY Arcadia TEL NO USE OF peS . IIUILDINGS ..LLll DISTRICT NO GROUP MAP PROCESSED BY BK pG CONTRACTOR Square Deal Sewer Service �d J— L ADDRESS 2933 Maxson Ad: CONNECTION DATA CITY El Monte TEL NO 444-2020 STATION j ' t"' DEPTH L CENSE NO 1.28876 s G RISS C-4'2 MANHOLE REFERENCE NO DESCRIPTION OF WORK FEE TYPE OFC CTIO LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L ML TOP L PUBLIC SEWER @ $7 00 PC NO SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $1000 CO IMP NO JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO O_ PRIVATE DISPOSAL SYSTEM _ @ $300 _ 0 1 CONNECT ADDITIONAL BLDG OR 00 AFFIDAVIT WAIVER EAS EM[XT RECORD INSTR NO DATE (� WORK TO HOUSE SEWER @ E3 00 OVERFLOW SEEPAGE PIT DRAINFIELD OC EXTN CESSPOOL DRYWELL @ ES 00 0 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING _ U SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENTd✓ MANHOLE $7 00 PERMIT NO ,'�"� W a INDUSTRIAL �� WASTE APPROVAL OWNER'S PERMIT $ 3 00 CHARGES AUTHORIZATION TOTAL FEE 1 61 00 CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DAT IN ECTOR SIGNATURE SIGNED THIS DAY OF 19 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OW ER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED RESID NTI/JL PROPERTY ABANDON HOUSE SEWER SIGNATURE /� J /' BACKFILL SEPTIC TANKS ❑ OF PERMITTEE r {{� SEEP PIT(5) EDCESSPOOLS ❑ VALID TION CK M O CASH / U _ 3 O 6 r tOv 27 1 0 o 6.0 0A .1 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1401300003 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT ILEGAL ID ISEWER / SEPTIC SEWER I BUILDING ADDRESS 1 ITR 11492 LT 2 BL C (EXIST OCC GRP I 9210 BLACKLEY ST 1 I IBLDGS NOW ON LOT I TEMP CA 917803136 1 (ASSESSOR INFORMATION NUMBER ICONNECTION TYPE I NEAREST CROSS STREET 1 18590-009-003 (ORIGINATION I THOMAS PAGE 596 GRID J4 LOCALITY TEMPLE CITY CAI I ILENGTH ML TO PL STATION DEPTH 11 1 ITENANT IMANHOLE REFERENCE UPPER/LOWER 11SSUED ON PROCESSED BY 1 1 101/30/14 SR 1 ICOUNTY IMPROVEMENT NUMBER I 10WNER TEL NO IPLAN CHECK NUMBER (FINAL DATE FIN BY CODE 1 IGONZALEZ, RC - IJOB NUMBER 1 19210 BLACKLEY ST ITRUNK PERMIT NUMBER ITEMP 917803136 IROAD PERMIT NUMBER IDLSCRIPTION OF WORK 1 IAFFADAVIT NO (INSTALLING SEWER CLEANOUT IWAIVER NO (APPLICANT TEL NO 1EASEMENT NO 1 ITODHUNTER, STACY (626)=858-9721- 1 - - - 1475 E ARROW HWY IRECORD INSTRUMENT NBR RECORD DATE ISPE--IAL CONDITIONS IAZUDA CA 91702 HIGHWAY/STREET WIDENING I ISTATE ENCROACHMENT PERMIT NUMBER 1),PAY CONTRACTOR TEL NO 1 FEES PAID IA P-�OVALS DATE IN ECTOR SIGNATURE 1 IRESCUE ROOTER (626) 858-9284- 1 1475 E ARROW HWY LIC NO IFEE DESCRIPTION QUANTITY UOM AMOUNT INEW HOUSE SEWER I I 1AZUSA CA 91702 765155 * 11 1 101 PERMIT ISSUANCE FEE 27 80 ICONQECT ADDITIONAL 1 1 13 WORK TO HOUSE SEWER 1 00 EAC 30 50 IBUI-DING OR WORK 1 (ARCHITECT OR ENGINEER TEL NO I TOTAL FEES 58 30 1 I - I ISEPiIC TANK, SEEPAGE PITI I1 LIC NO i (ANL'/OR DRAIN FIELD I 1 1 1DRYWELL I I I I SEWER MAP BOOK PAGE IALT-R REPA SEWER OR ISEWAGE SAL SYSTEM 1 IDISCONNECT PLUG AND I� IABAiQDON HOUSE SEWER I I I I IBACKFILL SEPTIC TANKS _ 1 I ISEEP PIT _ CESSPOOL _ i I I I I I IGRAfWATER SYSTEM I t 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* ADDITIONAL DATA ON FILE I I I I I I I REPORT ID DPR266 ROUTE TO BS0508 I