HomeMy Public PortalAbout9213 BLACKLEY ST_Sewer__ (
S✓}E6 SII 55 APPLICATION FOR PERMIT
DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of LOS Angeles BUILDI G
JOHN A LAMBIE COUNTY ENGINEER ADDREs
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY �' �/ �•
FOR APPLICANT TO FILL IN may,; CROSS ST
LEGAL 36�dT IZ�i� OWNER ��.L�/'/ 1��/
DESCRIPTION LOT NO
MAIL
BLOCK i TRACT �� �� ADDRESS
NO
SIZE OF LOT J/� 7 NOWOONBLOTS
CITY TEL NO
USE OF DISTRICT NO GROUP MAP
BUILDINGS
CONTRACTOR' aA��e _� BK MAP
ADDRESS /,+ —s9G` �„ CONNECTION DATA
CITS `GA TEL NO �2/ STATION- DEPTH -
Z. 9+--'
.,.,� MANHOLE REFERENCE
f LK STATE �C•fY��'
REGISTRATION NO / ❑ COUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3 50 d Y CURB P L M L TOP L
33
SEPTIC TANK SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD �� ,I P C NO
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP NO /�'Z / G JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NOc?'6_,d �
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 PERMIT NO
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
O
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECT -S�SIG NATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
�� NEW HOUSE SEWER d ��
SIGNED THIS w:2*olJ DAY O CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS ZZ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I VE REA THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AN AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STAT 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 SEW
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
ER
DESCRIBED RESIDENTIp�t1pROPERT/�`%�V�F`^�� BACKFILL SEPTIC TANKS❑ `
SIGNATURE � /) SEEP PIT(S) ❑ CESSPOOLS[I
OF PERMITTEE
JOHN A LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK� D0 0 CASH
IRS
® 6 0i IAM 27 4 A 4.5 0 lOn
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0304040004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT-
LEGAL
XT•LE A
TR: 11492 LT: 17 BL: 001 EXIST OCC GRP: 9213 BLACKLEY ST`
BLDGS NOW ON LOT TEMP CA 917803137
ASSESSOR INFORMATION CONNECTION TYPE: NEAREST CROSS STREET ENCINITA
8590-001-021 ORIGINATION: THOMAS PAGE. 596 GRID: J4 LOCALITY: TEMPLE CITY
LENGTH ML TO PL STATION: DEPTH.
MANHOLE REFERENCE UPPER/LOWER: ISSUED ON. PROCESSED ON
04/04/03 JK 10/01/03
COUNTY IMPROVEMENT NUMBER:
OWNER TEL. NO: PLAN CHECK NUMBER FINAL DATE FI BY: CODE•
PEREZ,GREG 8 CHRISTY (626) 286-2332- JOB NUMBER _
9213 BLACKLEY TRUNK PERMIT NUMBER-• „
TEMPLE CITY 91780 ROAD PERMIT NUMBER: � 0 WO
AFFADAVIT NO CO NECT7ADOITION TO HOUSE SEWER
WAIVER: NO
APPLICANT: L. EASEMENT NO
MASTER REMODELERS (STEVE KYNE) (626) 960-2951-
2149 W GARVEY AVE RECORD INSTRUMENT NBR RECORD DATE- SPECIAL CONDITIONS:
WEST COVINA HIGHWAY/STREET,WIDENING
STATE ENCROACHMENT-PERMIT NUMBER:
CONTRACTOR: TEL. NO: 1 1, �; FEES'PAID APPROVALS DATE INSPECTOR SIGNATOR
MASTER REMODELERS (626) 960-2951 !%����1
2149 W. GARVEY AVE NORTH LIC. NO FEE/DESCRIPTION: i, QUANT ITY-•"UOM:, AMOUNT: NEW HOUSE SEWER
- 6 3
WEST COVINA, CA 91790622749 HIC
01 PERMIT ISSUANCE FEE \ 27.75 CONNECT ADDITIONAL
WO
13 RK T0'HOUSEfSEWER1_l__'-, 1.00 EAC 30.45 BUILDING OR WORK
ARCHITECT0 TEL. NO: �' -�J _ TOTAL FEES `` ��, 58.20
> SEPTIC TANK,
LIC. NO:, ! AND/OR DRAIN FIELD
J ( iDRYWELL
SEWER MAP BOOK: PAG L _ ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
AND
- - ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS
SEEP. PIT CESSPOOL
GRAYWA
TER SYSTEM
* ADDITIONAL DATA ON FILE
REPORT ID: DPR266 ROUTE TO BS0508