HomeMy Public PortalAbout9707 BLACKLEY ST_Sewer__ 76A 6420 -CE808 -10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS Q (�' Qi
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST QS ve-
LEGAL
DESCRIPTION LOT NO OWNER (�e Q j J
MAIL
BLOCK TRACT ADDRESS '70-7rQC,
/ NO OF BLDGS. ��}.. / r //�
SIZE OF LOT-77 X NOW ON LOT CITY /e/h /e, C TEL, NO. �gJ ZI'�6
USE OF
BUILDINGS r�--3 KCom• DISTRICT NO GROUP BK MAP Po PROCESSED BY
CONTRACTOR Own e 1/ ZY-7 _v -
ADDRESS 70 B(2e Kr /,e- CONNECTION DATA
CITY o, TEL NO la?5-- STATION DEPTH
STATE LIC MANHOLE REFERENCE UPPER
LICENSE NO CLASS LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P•L M L TOP L
PUBLIC SEWER @ $7.00
P C NO.
SEPTIC DANK SEEPAGE PIT OR CO IMP. NO JOB NO _
PITS AND/OR DRAINFIELD @ E10 00 }
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO CL
PRIVATE DISPOSAL SYSTEM @ $300
0
'EIIS EMEr�T REC
CONNECT ADDITIONAL BLDG OR � AFFIDAVIT wAIvEN ORD INSTR NO, DATE V
WORK TO HOUSE SEWER @ E3 00 LTG/
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN CESSPOOL ORYWELL, @ $500 O
1--.
ALTER,REPAIR OR ABANDON HOUSE HWY OR ST WIDENING U
SEWER OR DISPOSAL SYSTEM @ E3 00 STATE ENCROACHMENT 11J
MANHOLE $7.00 PERMIT NO CL
E/)
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT S s 00 CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE -
TRACTOR TOCONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S 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 15 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 THA AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE AB V DESCRI ED RESIDENTIAL PROPER Y. ABANDON HOUSE SEWER
IGBACKFILL SEPTIC TANKS ElSIGNATURE ,
F'PERM ITTEE ❑ '
SEEP PIT(5) POOLS
VALIDAT M.O. CASH
Pr, 1 7 _373, J.N 1 8 1 0 D 6,0 G
78A84YD
C EsoAPPLICATION FOR P MIT
e a-ss COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE- ®OSP®�
BUILDING AND SAFETY DIVISION AD BUILDING
JHN A. LAMBIE, County Encineer
CAOSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN ceoss sr.
LEGAL •� J Lf��33�/G�GZ/
DESCRIPTION LOT N a�iL L+' y- ,fj` OWNER �/' ��/�, /�
MAI L
BLOCK TRACT `�� I r AD RESS ��_�//��/{�� C:::jP�,/�GLi �j��
NO.OF BLDGS
SIZE OF LOT NOW ON LOT CITY �rL- EL. NO. eOl/
USE OF DISTRICT N0. GROUP MAP PROCESSE Y
BUILDINGS '41�.s11�� ' I BK P I
CONTRACTORS
ADDRESS CONNECTION DATA
CITY_ ^ EL.N0. STATION r� DEPTH .� J
El'nTATE MANHOLE REFERENCE J 3 PPER
REGISTRATION N0. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
'f PUBLIC SEWER @ $3.00 p TYPE OF CONNECTION LENGTH FROM '
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
ITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD '
EXTN..CESSPOOL DRYWELL @ $2.00
P.C.NO.
CO.IMP. N0.
HOUSE SEWER CONNECTING TO �'�
PRIVATE DISPOSAL SYSTEM @ $1.00 O_ JOB NO.
CONNECT ADDITIONAL BLDG.OR ^"
WORK TO HOUSE SEWER @ $1 00 TRUNK PERMIT N0. ROAD PERMIT N0. 144 F
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE C) REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEW R. / f
SIGNED THIS Jg Do �Y 0 19_ NEW HOUSE SEWER
OWNER OR `�\_7J/:��}LL�_iOLCJ// _� CONNECT ADDITION
AL
OWNERS AGENT �� BUILDING OR WORK
ADDRESS /�, 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 ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 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 OF THE ABOVE
DESCRIBED RESIDENTIAL_JPRPPERTY. _ BACKFILL SEPTIC TANKS ❑ �'
SIGNATURE a� SEEP.PIT(S) ❑ CESSPOOLS
OF PERMITTE
®' VALIDATION ROBERT A. WOOD
cK. H.0, CASH SUPERVISING MECHANICAL ENGINEER
L ' 4438 i 7 _ D 5 .00
1
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0406100003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: -- — SEWER / SEPTIC: SEWER. - BUILDING-ADDRESS: -�—�
ON FILE EXIST OCC GRP: 9707 BLACKLEY ST -
BLDGS. NOW ON LOT: TEMP CA 917803929
ASSESSOR INFORMATION NUR—BER-.---- CONNECTION TYPE: NEAREST "CROSS-STREET: GOLDEN-WEST
8599-003-027 ORIGINATION: THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, C
LENGTH- ML TO PL: STAFION: DEPTH: -
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
COUNTY IMPROVEMENT NUMBER: 06/10/04 VG 12/07/04
-
OWNER: TEL. N0: PLAN CHECK NUMBER: FINAL DATE FINAL isY: CODE:
CORDES JOHN F;ANDREA M (626) 285-9006- IJOB NUMBER:
97057 B-ACKLEY ST TRUNK PERMIT NUMBER: `( _
TEMP 917803929 ROAD PERMIT NUMBER: DESCyIPTION OF WORK
AFFADAVIT: NO ON SITE SEWER REPAIR �'
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
SPEEDY STONE PLUMBING INC. (626) 282-5117-
RECORD INSTRUMENT NBR: iZECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CCNTRACTOR: — TEL. NO: — +' FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
SPEEDY STONE PLUMBING INC. (626) 282-5117-
307 N. SAN MARINO AVE LIC. NO FEE DESCRIPTION: •OUANFIlY: UOM: AMOUI' : NEW ?OUSE SEWER
SAN GABRIEL CA 91775 285376BC36 I I
01 PERMIT ISSUANCE 'FEE 27.75 CONNECT ADDITIONAL
_115 A'-T/REP HOUSE SEWER 1.00 EAC 30.45 BUILDING OR WORK
:^"At'ic:LT OR ENGINEER: TEL. NO- — AL FEES -C
- ND. cDANK, EPRL'E—�'T
LIC. N0: lAi<OjaR FI
DRAIN FIELD �
SEWER MAF BOOK: FFGr: _ IALTER, REPAIR, SEWER UR
E 87 SEWAGE DISPOSAL SYSTEM 2
�DISCONNECT PLUG AND !
ABANDON HOUSE SEWER �
ISACKFILL SEPTIC TANKS
SEEP. PIT _ CESSPOOL
!GRAYUATER SYSTEM --I —_--
I-
I
REPORT ID: DPR266 ROUTE TO SS0508 j