HomeMy Public PortalAbout9822 BROADWAY_Sewer__ AE-6D
S&E� APPLICATION FOR PERMIT
5 663 3-63
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Depaxtment of County Engineer
County Of Los Angeles. BUILDING ')
WM.J. FOX. COUNTY ENGINEER ADDRESS OC
® CASSATT D. GRIFFIN. 1U1'1 of Bml.olx6% LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST,
LEGAL I�
_DESCRIPTION LOT NO, E=4 OWNER
BLOCK TRACT /3g 0-2!G�d MAIL
N0ADDRESS
, OF BLOCS. -
SIZE OF LOT NOIV ON LOT / CITY TEL. NO.
USE OF
DI .f /J
BUILDINGS GK.XJ.y DISTRICT N0. GROUP MAP
BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
CITY TEL NO. -jr jT:j,_ STATION DEPTH
C3 STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. ❑ COUNTYA LOWER
NO. DESCRIPTION OF WORK FEE 4clel io N to # ;71:7 00_?
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L. TO P.L.
PUBLIC SEWER @ S 3.50 _
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR P. C. NO.
WORK TO HOUSE SEWER 1.00 CO. IMP, N0, JOB NO.
ALTER OR REPAIR EXISTING (7
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OP. DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK.SEEPAGE PIT OR
PI TI
AND/OR DRAINFIELD 2.00. INDUSTRIAL
CESSPOOL- ORYW ELL WASTE APPROVAL
SPECIAL CONDITIONS
ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNERS PEEMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
i HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS (DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19 NEW HOUSE SEWER 11T
OWNER OR 1 . �cf'L` �//J�p CONNECT ADDITIONAL 1
OWNERS AGENT \TL 4l� BUILDING OR WORK
p'�!! f, '
� SEPTIC TANK,SEEP,.PIT(S)
ADDRESS A�,X. �� �n AND/OR DRAINFIELD
IHEREPY ACKNOWLEDGE THAT 1. HAVE READICATION CESSPOOL❑ DRYWELL❑AND STATE THAT THE ABOVE IS CORRECT AND COMPLYWITH ALL COUNTY ORDINANCES AND STATE LATZ14G ALTER. REPAIR,SEWER OR ����� ((IIInp',�PLUMBING AND SEWERS. SEWAGE DISPOSAL.SYSTEM I CMI-.,yr"1l�1 HEREBY CERTIFY THAT 1 AM PROPERLY RAND/ORLICENSED AS REQUIRED BY LOS ANGELES COUNATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) ❑ CESSPOOLS❑
SIGNATURE.
OF PERMITTEE -
WILLIAM J. FOX.C U TY ENGINEER VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
3C 9 2 6 5u; OCT 21 4 2.0 0
I �
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 (SEWER°P.ERMIT"J
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE'O508-9903290005
BUILDING AND SAFETY ) LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER /-SEPTIC: S BUILDING ADDRESS:
TR: 13805 LT: 29 EXIST OCC GRP: 0822IBROADWAY
BLDGS. NOW ON LOT: TEMP'CA•917802633
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: GOLDEN WEST
8588-016-004 ORIGINATION: THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
03/29/99 UT 03/29/00
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
BECKWITH CHARLES E;JOANNE K - JOB NUMBER:
9822 BROADWAY TRUNK PERMIT NUMBER: G i
TEMP 917802633 ROAD PERMIT NUMBER: ESCRIPTION OF WOKK
AFFADAVIT: NO REPLACE SEWER LINE FROM HOUSE TO CURB
WAIVER: NO
APPLICANT: 77L. N0: EASEMENT: NO
GOOD DAY PLUMBING (626) 285-8080-
4013 ROWLAND AVE. RECORD INSTRUMENT�NBR: RECORD DATE: SPECIAL CONDITIONS:
EL MONTE, CA HIGHWAY/STREET-WIDENING•:1
STATE ENCROACHMENTLP,ERMI:TjNUMBER:
CONTRACTOR' TEL. NO: ///� F ES)PAID APPROVALS DATE INSPECTOR SIG URE
GOOD DAY PLUMBING (626) 285-8080- N „ �Y� 42
4013 ROWLAND AVE LIC. NO FEE,DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER /q
EL MONTE, CA 91732 565485 C36
� 01 PERMIT ISSUANC%FEE 27.75 CONNECT ADDITIONAL
.15 ALT/REP°HOUSE-SEWER 1- EAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. NO: TOTAL FEES 58.20
// SEPTIC TANK, SEEPAGE PIT
LIC. NO: 1111111 AND/OR DRAIN FIELD
DRYWELL
SEWER MAP BOOK: PAGE: I IL CI DO ��� n I��I�II� ALTER, REPAIR, SEWER OR
1J v v v w u� SEWAGE DISPOSAL SYSTEM
5 D CONNECT PLUG AND
S ABANDON HOUSE SEWER
C7 D
BACKFILL SEPTIC TANKS _
SEEP. PIT _ CESSPOOL _
GRAYWATER SYSTEM
Service Thal
* ADDITIONAL DATA ON FILE
REPORT ID: DPR266 ROUTE TO BS0508