HomeMy Public PortalAbout9059 BROADWAY_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
AUDRESS
FOR APPLICANT TO FILL IN LOCALITY
J� f, 01 C
BUILDING ADDRESS �� � A NEAREST
PTCI CROSS ST.
LOCALITY �� DISTRICT NO. SERIAL N0. PERMIT N0.
NEAREST -J - A /� /¢� $
CROSS ST. _
/ RECEIVED BY Ready for Ineoecti.n ,p DATE ISSUED
OWNER ) 61
MAIL J
ADDRESS . USEZONE OCCUPANCY K•MAP^
PG
CITY L./ �FEL.NO. h 6--0-06 p0.�4 , L — 7
CONTRACTOR ! ilr-/
CO.IMP.NO. 1,37.2 -1,4
ADDRESS /� �- /-/ JOB NO.
CITY 11L �TEL:NO. �J
QTRUNK PERMIT NO.
TATE
REGISTRATIO N0. ,(J COUNTY ROAD PERMIT NO.
LEGAL - /.
DESCRIPTION LOT NP O. /O�J 4�O•Wim(^ pERMET NO ENCROACHMENT
BLOCK TRACT,&yJ)N�U/ C LOT*jy INDUSTRIAL
S f NO.OF BLDGS. WASTE APPROVAL
SIZE OF LOT / NOW ON LOT ,(/ CHARGES
USOF
BUELDINGS _(d1j�• CONNECTION CHARGE FEE
NO. DESCRIPTION OF RK FEE
HOUSE EWER CONNECTING TO _REIMBURSEMENT FEE \ /
PU BLIC SEWER @ j 3.50 �.,RECEIPT NO. \ I ^ATE I BY
HOUSE SEWER CONNECTING TO /
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR / �,Q �, EXCEPTION RECORDED
WORK TO HOUSE SEWER ..i. U
ALTER OR REPAIR EXISTING NO.
SEWER OR DISPOSAL SYSTEM 1.00 - �I�' DATE I BY
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 v / /
CESSPOOL—DRYWELL STATION ,i�� ? 7"" _ DEPTH
SPECIAL CONDITIONS ONLY 2.00 ry/ .. MANHOLE REFERENCE/ . X L . . UPPER LOWER-
TYPE OF CONNECTION LENGTH FROM .y /
OWNERS PERMIT $ 1 00 -Y CURB •P.L. M.L.TO P.L. ?
AUTHORIZATION TOTAL FEE" g �Q
'CONTRACTOR
THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOV DESCRIBED EXISTING SIGNATURE DATE
DWELLING TO TXE Pu BLIC SEWER
SIGNED THIS----.._G~.........DAY OF.. .I.... .........1 __ NEW HOUSE SEWER INSPECTOR'S SIGNA lf-lzor-
ECT
OWNER OR �L7/ ------.. ---- ............. ......._ BUILDING OR WORK OWNERS AGENT./..�.......y'-y ......._.
ADDRESS..... Q ... SEPTICTANK,GRAINFIELD PIT(S)
'- '------ ANO/CRANK,SEEP.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL El
THEREBY
STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR.SEWER OR -
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY w
AND STATE OF CALIFORNIA OR THATlf-AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE D CRIBED R SIDENTIAL PROPERTY./ BACKFILL SEPTIC TANKS
�I �oJ,f / SEEP.PIT(S)� CESSPOOLS ( �/
'
SIGNATURE
OF PERMITTEE..._. i.._. ...'y.. 4
7 A042 663 1/53
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0205220003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER SEP C: Y G ESS:
ON FILE EXIST OCC GRP: 9059 BROADWAY
BLDGS. NOW ON LOT: TEMP CA 917802312
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: SULTANA
5387-026-007 ORIGINATION: THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED Y: EXPIRES ON:
05/22/02 JK 11/18/02
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. N0: PLAN CHECK NUMBER: - FINAL D TE FINAL BY: CODE:
KUH;GLORIA (626) 307-1648- JOB NUMBER:
9059 BROADWAY TRUNK PERMIT NUMBER: /���� rte•
TEMPLE CITY 91780 ROAD PERMIT NUMBER: OF WORK
AFFADAVIT: NO SEWER FOR NEW SFR
WAIVER: NO
APPLICANT: TET 770: EASEMENT: NO
KIM WONG PLUMBING (626) 448-1383-
9631 ALPACA ST RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
S EL MONTE 91733 HIGHWAY/STREET�WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO- FEES.PAID APPROVALS DATE INSPECTOR SIGNATURE
KIM WONG PLUMBING (626) 448-1383-
9631 ALPACA ST. LIC. NO FEE,DESCRIPTION: - QUANTITY'. UOM: AMOUNT: NEW SEWER
/
SOUTH EL MONTE CA 91733 752619 B * /f �� 11
/) ��
01 PERMIT ISSUANCE FEE. 27.75 CONNECT ADDITIONAL
03 CONN.TO�PUBLIC-SEWER 1.00 CON46.95 BUILDING OR WORK
ARCHITECT OR G N N0: TOTAL FEES 74.70
SEPTIC TANK, SEEPAGE
LIC. NO: /r- _ AND/OR DRAIN FIELD
DRYWELL _
SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER-UR-
SEWAGE
EWERORSEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC ANS _
SEEP. PIT CESSPOOL
GRAYWATER SYSTEM
* ADDITIONAL DATA ON FILE
REPORT ID: DPR266 ROUTE TO BS0508