HomeMy Public PortalAbout9840 BROADWAY_Sewer__ TBAE42-660
�- APPLICATION FOR PERMIT
3 @ S 11.511'
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL//
Dsp of County Engineer
County of Los AnDies BUILDING
IN
ami
JOHN A. LAMBIE, COUNTY ENGINEER
PL F e /'yf
® CASSATT 0. GRIFFIN. SUPT OF BUH-OING LOCALITY
FOR APPLICANT TO FILL IN CRosss SIT. A^ r
LEGA!
DESCRIPTION LOT N0. 2 OWNERMAIL
/��) �J ~cM ¢ �} A� �{�A
BLOCK TRACT 3 �(/ \J ADDRESS SrA V/'` 1 ����/r A� �'fJ'ry
SIZE OF LOT
! `'NOW ON OF LOTS CITY GC 6 N0.
USE OF DISTRICT NO. GROUP MAP
BUILDINGS �.
BK PG
CONTRACTOR '_ ,�
•� CONNECTION DATA
aoDREss L
STATION DEPTH
'. CITY EL. NO. C�C/1-I MANHOLE REFERENCE, UPPER
❑ STATE LOWER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
V. CURB P.L. M.L. TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD i - P C NO.
EXTN..CESSPOOL.URYWELL,MANHOLE @ $ 2.00 CO.IMP. NO. L^ JOB N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM n $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ S 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM , $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 3 t DD
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED co N. APPROVALS DATE INSPECTOR'S SIGNATURE
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT I SEPTIC TANK,SEEP,PIT(S) I
ADDRESS _ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ ORYW ELL Ll
WITH
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
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 REOUIRED BY LOS ANGELES COUNTY AND STATE OF _ ABANDON HOUSE NEW ER
CALIFORNIA OR THAT AM THE LEGAL DIANE @@ OF HE ABOVE
DESCRIBED RESIDENTI PROPERTY. BACKFILL SEPTIC TANKS Ll SEEP. PIT(S) LI-CESSPOOLS❑
OF PERM ITTEEI f
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK.
LACO7 0 6 1 APR 11 4 2.0 O N
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1201240007
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: ISEWER / SEPTIC: SEWER BUILDING ADDRESS: 1
ITR: 13805 LT: 32 (EXIST OCC GRP: 9840 BROADWAY
_IBLDGS. NOW ON LOT: TEMP CA 917802633
1ASSESSOR INFORMATION NUMBER: (CONNECTION TYPE: NEAREST CROSS STREET:
18588-016-007 (ORIGINATION: THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl
LENGTH ML TO PL: STATION: DEPTH:
I TENANT: (MANHOLE REFERENCE: UPPER/LOWER: (ISSUED ON: PROCESSED BY:
1 101/24/12 SR
I ICOUNTY IMPROVEMENT NUMBER: I I
IOWNER: TEL. N0: PLAN CHECK NUMBER: F11INAL DATE I FINAL
��(,{{/) CODE: 1
10 LEARY DENIS (626) 286-4347- 1COB NUMBER: 1 ! `� • 1`
19840 BROADWAY ITRUNK PERMIT NUMBER:
TEMP 917802633 ROAD PERMIT NUMBER: IDESCRIPTION OF WORK
AFFADAVIT: NO INSTALL SEWER CLEAN OUT
(WAIVER: NO
1APPLICANT: TEL. NO: (BASEMENT: NO 1 1
IRESCUE ROOTER (626) 858-9284- 1
]RECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS: I
1 HIGHWAY/STREET WIDENING: 1
STATE ENCROACHMENT PERMIT NUMBER: 11
' I_, )'- 5` 1�e *y'd
(CONTRACTOR: TEL. NO: FEES PAIp ABPR`OVALS w� DATE INSPECTOR SIGNATURE
IRESCUE ROOTER (626) 858-9284- I
1475 E ARROW HWY LIC. NO IEEE DESCRIPTION: QUANTITY: UOM: AMOUNT:INEW HOUSE SEWER
JAZUSA CA 91702 765155 C42 •1 1 11
1 101 PERMIT ISSUANCE FEE 27.80 ICONNECT ADDITIONAL I
115 ALT/REP HOUSE SEWER 1.00 EAC 30.40 BUILDING OR WORK 1
ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.20 1
- I (SEPTIC TANK, SEEPAGE PITI
LIC. NO: I AND/OR DRAIN FIELD
I
I I IDRYWELL
I
SEWER NAP BOOK: PAGE: IALTER,REPAIR, SEWER OR
ISEWAGE DISPOSAL SYSTEM
I I IDIS CONNECT eLDc AND I I I
ABANDON HOUSE SEWER
1
BACKFILL SEPTIC TANKS _1
ISEEP. PIT _ CESSPOOL
--l-1
GRAYWATER SYSTEM
I I I I I I
I I I I I I
I I I I I
I I I I I I
I I I I I I
I I I I I
I I I I I I
I I I I I I
` ADDITIONAL DATA ON FILE
REPORT TD: DPR266 ROOTS 'PO BS 0508