HomeMy Public PortalAbout9920 BROADWAY_Sewer__ aaE°;311.55 APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUiLolrvo A
LOGLITY
FOR APPLICANT TO FILL IN ceoss sr.
LEGAL OWNER
DESCRIPTION LOT NO.
/ 3 ® O MAIL
BLOCK TRACT ADORES
N0. OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF 71
BUILDINGS DISTRICT NO. GROUP MAP
BK PG
CONTRACTORP7r
Ile /
ADDRESS
CONNECTION DATA
1
CITY TEL. NO. T%�� STATION y DEPTH ,
7, MANHOLE REFERENCE _ UPPER
LYIIATE LO R
REGISTRATION NO. ❑ COUNTY ,
NO. DESCRIPTION OF RK FEE
HOUSE SEW ER CONNECTING TO T J TYPE OF CONNY. CURBE T N. LENGTH FROM
PUBLIC SEWER @ $,3,yg d(/ P.L. M.L. TO P.L. J
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR GRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD / �� P. C. NO.
EXTN..CESSPOOL.DRYWELL.MANHOLE @ $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO 9/
PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT NO. ROAD PERMIT NO (�(�
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Gy $1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEW ER-OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS 46 OF ✓Al"04,19 /
L "� CONNECT ADDITIONAL
OWNER OR ✓d/3�`�'/QifTA�rd�- ,P��YY BUILDING K,WORK
OWNERS AGE N7�7T���f/����� �//5S5,,�`�` ��fA/'••� SEPTIC TANK,SEEP,PIT(S)
ADDRESS. ?'210 - \ AND/OR DRAINFIELD
I HEREBY ACKNO LEDGEGEE THAT I HAVE R HIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND GREE 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 REQUIRED BY LOS #NGELES COUNTY A STA F ISC O NECT PLUG HOUSE AND
CA LIFORE OR THAT AM THE�LEGAOWNER HE OVDESCRIRNI16 ROR TH T gBANDONCKFILL SEPTIC TANK$❑SIGNgTUR ! A dSEEP.PIT(S) ❑ CESSPOOLS1OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. X.O. CASH
$ . LQ
1149 JAN 12'1 O A 5.00
COUNTY OF LOS ANGELES TEMPLE CITY N 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BE 0508 1302060006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: ISEWER / SEPTIC: N BUILDING ADDRESS:
ITR: 13805 LT: 38 IEXIST OCC GRP:
9920 BROADWAY
_IBLDGS. NOW ON LOT: TEMP CA 917802618
ASSESSOR INFORMATION NUMBER: I CONNECTION
CTION TYPE: NEAREST CROSS STREET-
18588-016-013 (ORIGINATION: THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY CAI
(LENGTH ML TO PL: STATION: DEPTH:
(TENANT: IMAN HOLE REFERENCE: UPPER/LOWER: (ISSUED ON: PROCESSED BY:
102/06/13 SR
COUNTY IMPROVEMENT NUMBER: I I
IOWNER: TEL. NO: (PLAN CHECK NUMBER: IFINAL DATE F CODE:
IDIENER, CAREL (626) 497-9034- ISOB NUMBER:
19920 BROADWAY TRUNK PERMIT NUMBER: �� /
TEMP 91]802618 ROAD PERMIT NUMBER: DESCR PTION OF WORK
AFFADAVIT: NO ISEWER MAIN REPAIR
_IWAIVER: NO
(APPLICANT: TEL. NO: EASEMENT: NO
IMADDIAN, ARAM (818) 262-3604-
17949 AJAY DR IRECORD INSTRUMENT NBR: RECORD DATE: JSPECIAL CONDITIONS:
SUN VALLEY CA 91352 HIGHWAY/STREET WIDENING:
1 STATE ENCROACHMENT PERMIT NUMBER:
1
CONTRACTOR: TEL. NO: I FEES PAID (APPROVALS 4TENSPECTOR SIGNATURE
(URGENT ROOTER (818) 587-4368- 1 ' I
17949 AJAY DR. LIC. NO IEEE DESCRIPTION: QUANTITY: DOM: AMOUNT: INEW HOUSE SEWER 1
SUN VALLEY, CA 91352 - 887603 C36 I
-
1 101 PERMIT ISSUANCE FEE 27.80 ICONNECT ADDITIONAL
115 ALT/REP HOUSE SEWER 1.00 EAC 30.50 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.30 1
- I ISEPTIC TANK, SEEPAGE PITT I
LIC. NO: I AND/OR DRAIN FIELD
I_
I I tIDRYWELL
SEWER MAP BOOK: PAGE: (ALTER, REPAIR, SEWER OR
SEWI.GE DISPOSAL SYSTEM
I � I
IDISCONNECT PLUG AND
ABA'DON HOUSE SEWER
IBACKFI SEPTIC TANKS
5 EEP. PIT CESSPOOL
GRAYWATER SYSTEM
I I I
(REPORT ID: DPR266 ROUTE TO BS0508
I I I I I I