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Home My Public Portal About9663 BROADWAY_Sewer__ CEBOB3-fi2 7fiAfi92D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION Bu1LDING JOHN A. LAMBIE. County Engineer WILLIAM A. JENSEN, Su P't of Building ��//�—^""/'T LOCA LITY � NEAREST FOR APPLICANT TO FILL IN `ROSS ST. LEGAL J / /� ,[ DESCRIPTION LOT NO./oIt _z -/ O / _IS OWNER /// MAIL BLOCK TRACT 14 ADORES$ NO. OFBLDGS. SIZE OF LOT � NOW ON LOT / CITY WTEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY PG BUILOINGB BK N I CONTRACTOR y� I. ^ ADDRESS �' d�'' �Ij CONNECTION DATA "l— CITY TEL. NO. �� - ST 1 < DEPTH STATE MANHOLE REFERENCE `l REGISTRATION NO. COUNTY D LOWER - NO. DESCRIPTION OF WORK FEE T EOFC NNE 1 LENGTHF OM HOUSE SEWER CONNECTING TO � M.L.TOP w O PUBLIC SEW ER ® $5.00 PC NO SEPTICTANK.SEEPAGE PIT OR •CO.IMP.NO. JOB NO. V PITS qNO/OR GRAINFIELD $10.00 HOU BE SEWER CONNECTING TO rrjj LY. PRIVATE DISPOSAL SYSTEM $3.00 TRUNK PERMIT NO. ROAD PERMIT NO. / CONNECT AUDIT I ONAL BLOC.Oft gFFl Ow VIT en Rsu[x RECORD,INS R,NO, OA/TE WORK TO HOUSE SEWER ® 53.00 v [R E OVERFLOW SEEPAGE PIT.DRAINFIELD T EXTN..CESSPOOL.DRYWELL.MANHOLE 0 $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL VIASIXt APPR A OWNERS PERMIT s z 00 AUTHORIZATION TOTAL FEE I CONNECTION CHARGE FEE I HAVE AT THISDATE A CONTRACT WITH THE HEREIN pAHED CO, REIMBURSEMENT.FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTIG(O OWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR55IGNA REI SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ _ CONNECT ADDITIONAL BVILDING OR WORK ADDRESS 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAISEPTIC TANK.NFIELD SEELD (S) AND STATE THAT THE wICORRECT AND AGREE COMPLY WITH ALL COUNTY ORDINANCES S ANO STATE LAWS REGULATING PLV MBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL F. AND INTEND TO RESIDE IN, THE ABO ESCRIBE NTI PROPEflTY. —DISCONNECT PLUG AND ABANDON HOUSE SEWER SIGNATURE OFFERMRTEE BACKFILL SEPTIC TANKS ❑ OF ER ❑ SEEP.PITIS) ❑ CESSPOOLS VALIDATION ROBERT WOOD/ SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH �3Co 2 3 7 9 w tars 2 2 1 0 0 7.0 0 CEBOBAPPLICATION FOR PERMIT TsaBazD IIJJ COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION au1LD wG JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN. Supt of Building OGLRY / NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL �I -o-� gP.�� a DESCRIPTION LOT NO. IF--j OWNER l Lf� p MAIL BLOCK TRACT ADDRESS �llsa y NO. OF BLOTS. SIZE OF LOT NOW ON LOT CITY_ / ( EL. NO. VSE OF ' BUILDINGS .-G�GL��h OISTRICTNO. GROU MAP PC PROCESSED BY R � �� e-l�- l7 3 4� CONTRALTO f ADDRESS �� /JL-!/7/f CONNECTION DATA CITY �j•j'7 � f EL. NO. �/ 62� ST N DEPTH TATE MANHOLE REFERENCE REGISTRATION NO. / COUNTY f LOWER NO. DESCRIPTION OF.WORK .FEE T EOFC N �)� LENGTH FIR M y a HOUSE SEWER CONNECTING TO Y. M.L.TO P.L O PUBLIC SEWER @ E3.00 P.C.NO. SEPTIC TANK,SEEPAGE PIT OR CO.IMP.NO. JOB NO. u PITS AND/OR GRAINFIELD @ $10.00 HOUSESEWERCONNECTINGTO G O PRIVATE DISPOSAL SYSTEM E3.00 TRUNK PERMIT NO. ROAD PERMIT NO. a O CONNECT ADDITIONALBLuv M [[ uDG.OR AFFIDAVIT [[K[xi RECORD.INSTR.NO, DATE WORK TO HOUSE VSE SEWER ER Q E3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL.MANHOLE N E5.00 HWY.OR BT.WIDENING _ ALTER.REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL YS M E3.00 STATE ENCROACHMENT PERMIT NO. V L� INDUSTRIAL WAS APPROVAL RTES OWNERS PERMIT S � CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 1 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 I NSPECTOR'SSIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ CONNECT ADDITIONAL BUILDING OR WORK ADDRESS 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 ❑ 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR LICENSED AS REOUIRED BY LOS ANGLES OUNTY ANDSTATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 M THE LEGAL NE OF. NO INTEND TO DISCONNECT PLUG AND RESIDE IN.SIGNATURE THE qB0 SC R ENT PROP pBAN OON MOUSE SEWEfl OFPERBACKFILL SEPTIC TANKS ❑ OF PERMITTEE— SEEP.PIT ISI ❑ CESSPOOLS ❑ /'�JALIDATION ROBERT A. WOOD L-K; M.0. CASH SUPERVISING MECHANICAL ENGINEER 1.17L'O ? 3 a 02 2 2 1 i e 2 5.0 0 �`� 2� CITY OF, TEMPLE CITY ` A62 T6A642D6C2D APPLICATION FOR PERMIT y� u COUNTY OF LOS ANGELES - SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILD'NG 8663 Broadway JOHN A' LAMBIE, County Engineer ADDRESS - WILLIAM A. JENSEN, Supt of''Building' p LOCALITY _ele Ci t - "`"REST Temple' City B l.vd.. �F AP.PPLICANT T FILL IN CR 5T DESCRGPTION OTNO -( OW NEE J / MAIL BLOC / L AD0RE55 N°, OF RIOGS. SIZE OF LOT - NOW ON LOT CITY TEL. NO. USE OF d BUILDINGS DISTRICT NO. GROUP MAP ED PROCES5ED BY OK CONTRACTOR Joseph Cadilli Plbg . Co. 5 3 ADDRESS ]871 t _cia_r_V2 Ave. CONNECTION DATA .CITY.,S_, San Gabr i eTIL. NO. 280-534 X STATION DEPTH REGISTRATION NO. 134935036 0 STATE UPPER ❑ COUNTY MANHOLE REFERENCE. _ LOWER NO, DESCRIPTION OF WORK FEE TYPE.1 CONNECTION LEND HOUSE SEWER CONNECTING TOY. CURB P.L, M:1,TMR PUBLIC SEWER � .SS.00 O SEPTIC TANK,SEEPAGE PIT OR PITS ANO/OR O BAINFIELD @ 510.00 CO.,IMP -JOB'NO. V HOUSE SEWER CONNECTING TO P R V p TNO. ROAD'PERMIT NO. O E DISPOSAL SYSTEM @ 3. 5 °0 CONNECT ADDITIONAL BLDG.OR - 00 AFFIDAVIT Ary 511INr ECORO.-INSTR.NO. DATE 1 WORK TO.HOUSE SEWER. - @ $3.00 3 OVERFLOW SEEPAGE PIT,GRAINFIELD E%TN..CESSPOOL.DRYWELL.MANHOLE@ SS.00 (A ALTER.REPAIROR ABANDON HOUSE HWY,ON ST.WIDENING Ly, SEWER OR DISPOSAL SYSTEM @ $3,00 STATE ENC ROwCHMENT PERM IT NO. _ INDUSTRIAL WASTE:APPR AL OWNERS PEAMRCHARGES • E z o0 Q— 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 E%ISTING DWELLING TO THE PUBLIC SEWER, APPROVALS DATE - INSPECTOR'S SIGNATURE SIGNED THIS. DAY OF 19— �j � OWNEROR - NEW HOUSE SEWER f .__(v'yI OWNERS AGENT_ CONNECT ADDITIONAL y �� ADDRESS BUILDING OR WORK / SEPTIC TANK:SEEP.III(S)- K _ IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY .WITH ALL COUNTY ORDINANCES .AND STATE LAWS REGULATING PLUMBING AND SEWERS_. CESSPOOL ❑ DRYWELL []' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND °R ALTER, REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT AM TJJ,E LED REP NER OF, AND INTEND TO, ,DISCONNECT PLUG AND RESIDE IN, THE ABOVEORI EO'.RES ID ENT Ip RR�ERTY. 1 ABANDON HOUSE SEWER SIGNATURE {� B A,PFLL.EETIC•TANKS ❑ OF pERMiTTEE ♦�) - 'e r SEEP. PIT IS) ❑ .CESSPOOLS ❑ / VALIDATION RoaeRr wood ATO, - cgSM _SUPERVISING MECHANICAL ENGINEER 0 a.3 3:E" SEP 30 1 0 D 5.00~ `v