HomeMy Public PortalAbout9303 BROADWAY_Sewer__ DEPARTMENT OF COUNTY E Gnvffit . SEWER—SEWAGE DISPOSAL-
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COIINTY OF LOS ANGELES _
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING O ? c SYo�z. /u fa
ADDRES8 -J /J /�•.�C.f�
FOR APPLICAN TO KILL IN LOCALITY
BUILDING NEAREST • /? e,�t /
BUILDING
ORE NEARGROSST. ..0 C
LOCALITY DISTRICT NO. I Ready for Inspection PERMIT NO
NEAREST KI/__r 3 S
CROSS ST.
EI D/g(Y �QATfISSUED BY DATE
^
OWNER
MAIL
ADDRESS _ U�SSE ZONE OOCCCUPAN MAP pa
CITY TELNO. ')., '�(1 6Z I 0/ BK
134
CONTRACTOR
CO.IMP.X0.
ADDRESS . JOB.NO.
CIT TEL.NO. TRUNK PERMIT N0.
TATE p
ftEGI6TRATION N0. L COUNTY ROAD PERMIT N0.1 !V"
LEGAL _ STE ENCROACHMENT
DESCflIPT10N LOT N0. PER T N0.
BLOCK TRACT D INDUST L
WASTE APllnVAL
SIZE OF LOT NO.OF BLOTS. ,� CNARG _
NOW ON LOT
USE OF
BUILDINGS ✓ CONNECTION CHARGE
NO. DESCRIPTION OF W K FEE REIMBURSEMENTF
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ® F 3.50 RECEIPT I -DA IBY
HOUSE SEWER CONNECTING TO
_ P R IVATE DISPOSAL SYSTEM 1.00
CONNECT ADOITI O NAL BLDG.OR EXCEPTION RECORDED
_ WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE .t I BY
_ SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
S EPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION /' DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 `I MANHOLE REFERENCE
025931, LOWEfl
TYPE.OP�ORNMECTIOM LENGTH FROM �J
Y. CURB J P.
M,L.TO P.L. .7
OWNERS PERMIT = I DD
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HERE N NAMED
CONTRACTOR TO CONNECT THE ABOVE'DESCRIBED EXISTING APPROVALS INS PE TOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWE
SIGNED THIS.4,�_._DAY OF 19AC:r NEW HOUSE SEWER
OWNER OR ' CONNECT ADDITIONAL
OWNERS AGENT—�.. BUILDING OR WORK
TANKSEEP.
ADDRESS C. :na_.�. _ A D/OR GRAINF ELD PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVEAD THIS APPLI• CESSPOOL[3 DRYWELL0
CATION ANO STATE THAT THE ABOVE IS GIGECT AND AGRE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATELAWB ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE REPAIR.
DISPOSEWERAL R
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/OB LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA 0 THAT I AM TAE EGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DE ED RESIDENTI VP PERTY. BACKFILL SEPTIC TANKS ''p1- _
SEEP.PIT(S)E] CESSPOOLg (]C._�_ 7 S
SIGNATURE ,
OF PERMIT EE...__
76A642D S&E 663 4/54
,i
'"446$0;INSERTS:,'':
°EB086
•60 - APPLICATION. FOR PERM. T:� 1 r.- , •,x_,;. -:�r
'°""�° COUNTY OF LOS ANGELES SEWER-SEWAGE,_DISPOS 1 I
• -
'DEPARTMENT OF COUNTY ENGINEER—
BUILDING AND SAFETY DMSION BUILDING i1O�. i _ I_
gg�� 'ADDRESS ../
WJIL.IN7A A. JENSEN. Sup'! of Building 'LOCA LI 67 - •'
'NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT N0. / OWNER,MA L
-
I BLOCK CC TRACT �0 'AD RESS
SIZE OF LOT V �{ 1,5r-6- NO,OF NOW ON LOT S / .CITY TEL. NO.
USE OF - (J��IL Fir �[!�
BUI 01", • - DISTRICC GROUP - K MAP I RO ESSE
CONTRACTOR` '\J (I ��
ADDRESS 4q / CONNECTION DATA
CITY / EL.N0. �/ iSTATION DEPTH
ASTATE MANHOLE REFERENCE PPER
REGISTRATION NO. Cl'✓r COUNTY
Nob DESCRIPTION.OF WORK FEEHOUSE ) -
PUBLIC WR
SEWER
CONNECTING TO CO.53.00 OO
TYPE OF CONNECTION LENGTH FROM
PETS ND/OR DRAPTIC TANK, ENFIIELDIT OR @ $3.00 Y. LURE P.L.
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL. DRYWELL C $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM - $1.00 ,CO. IMP. N0. OB NO.
- CONNECT ADDITIONAL BLDG.OR •5 P'
WORK TO HOUSE SEWER @ 41.00 TRUNK PERMIT N0. ROAD PERMIT N0. a/ o'
ALTER.REPAIR OR ABANDON HOUSE 'STATE ENCROACHMENT 0
SEW RP DISPOSAL SYSTEM @ 81.00 PERMIT NO. 0
INDUSTRIAL I'
WASTE APPROVAL W
CHARGES N
OWNER'S PERMITTOTAL $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION FEE e) REIMBURSEMENTFEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE ANSPECTOR-S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS _ Y ONEW HOUSE SEWER'Ny°Tb�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT -BUILDING OR WORK{
ADDRESS
SEPTIC TANK,SEEP:PIT(5)
AND/OR DRAINFIELD J 1`
I HERE ACKNOWLEDGE THAT I HAVE READ AIS APPLICATION-
AND STATE, THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I .AM PROPERLY REGISTERED AND/OR, DISCONNECT PLUG AND.
LICENSED AS. REQUIRED BY LOS ANGELES_QWLNIrY AND STATE OF, 'ABANDON HOUSESEWER
CALIFORNIA OR THAT L,AM THE J.EG OW OF THE ABOVE
DESCRIBED RESIDENT R --- Y BACKFILL SEPTIC TANKS ❑ ,
T
- SEEP.PIS) C1-CESSPOOLS I-
SIGNATURE
OF PERM ITTE
Or /-VALIDATION ROBERT A WOOD,'
Y.°. WH SUPERVISING MECHANICAL ENGINEER. -_
LAl63204 AUG 1. 710 D . 7.00- Q _ .
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0201040001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: S / • BUILDING ADDRESS:
TR: 12410 LT: 7 EXIST OCC GRP: 9303 BROADWAY
BLDGS. NOW ON LOT: TEMP CA 917802404
ASSESSORN 0 R: + CONNECTION TYPE: NEAREST CROSS STREET: HILTON
8588-002-007 ORIGINATION:^ `, THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON:. PROCESSED EXPIRES 0 : .,
01/04/02 JK 07/03/02
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL- 0: PLAN CHECK NUMBER: - FINAL DATE
JIMENEZ; CARLOS (626) 309-9505- JOB NUMBER: - I..
TEMP917802404NUMBER: E
039 GOLDEN WE57 AVE ROADTRUNKPERMPERIITTNUMBER: DESCRIPTION XPIR �
_ AFFADAVIT: NO REPLACE SEWER LINE
WAIVER: NO
APPLICANT: TEL- EASEMENT: NO
SAME AS OWNER
RECORD INSTRUMENT NBR: __ RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET:WIDENING:
STATE ENCROACHMENT-PERMIT,•NUMBER:
CONTRACTOR: TEL. N0: -FEES.PAID APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER _ �'.�;�,�
LIC. NO FEE DESCRIPTION' OUANTITY:�UOM: . • AMOUNT: NEW HOUSE-SEWER
0// /ice G� f -
01 PERMIT ISSUANCE FEE `� 27.75 CONNECT ADDITIONAL
03 CONN'+,T0IPUBLIC'"SEWER1.00 CON, 46.95 BUILDING OR WORK
ARCHITECT OR EL. O: �T _ ❑' - NOTAL FEES 74.70
SEPTIC TANK, SEEPAGE PIT
LIC. NO: (/ _ _.� rh � � �� AND/OR DRAIN FIELD
DR ELL _
SEWER MAP BOOK: PAGE: - ALTER, REPAIR, SEW R.OR
11 - SEWAGE DISPOSAL SYSTEM
DISCONNECT G AND
1 J - - ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS
SEEP. PIT _ CESSPOOL _
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO BS0508