HomeMy Public PortalAbout6148 CAMELLIA AVE_Sewer__ DEPA$T)1SENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAYETY PERMIT APPLICATION
OOUNTY OF LOS ANGFff Q8
WILLIAM J. FOX:, COUNTY ENGINEER BUADDRE88ILDING
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R APPLICANT TO RLL IN LocALITY�1
BUILDING 'n/g.r& �- l _�J� LI_ . NEAREST
ADDRESS /`p`J �j/1J` OROSa 8T.
LOCALITYDISTRICT NO. SERIAL NO. PERMIT NO.
A -.-I- -
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NEAREST /`��J �v
CR0888T. (�tif]IG ,�.V7L- R CEIVEDBY Ready for lstRwUov DATE ISSUHD
OWNER ��
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CITY-;EyC TELMO. Q TRUNK PERMIT NO.
Sf'Z//� STATE
REGISTRATION NO. LINTY ROAD PERMIT NO. ------
LEGAL STATEENCROAOHMENT
DESCRIPTION LOT NO. p PERMIT NO.
BLOCK TRACT �33g' INDUSTRAIAL ^------�
WASTE PPROVAL
81Z[OF LOT� ^ Y� COWDoN�LoO?S CHARGES
USE
BUILDINGS CONN N CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER DOWNECTINd TO REIMBURSEMENT
PUBLIC SEWER L8a RECEIPT NO. E BY
HOUSE SEWER OONNIEffiNGTO
PRIVATE DISPOSAL SYSTEM LN
GONNEOT A BL G.OB EXCEPTION REOORDE
WORK TO HOUSE SEWER 1.90
ALTER OR REPAIR ISTINB N0. DATE B
SEWER OR DISPOSAL SYSTEM 1.00
ISCON E T AND ABANDON SEWER
AND OCRDISPOSALSYSTEM 1.00 CONNECTION DATA
HPTITANK,SEEPAGE PIT OR
PITS AND ORDRAINFIELD 2JNI STATION Q DEPTH cen
POOL—DRYWELL
SPECIAL CONDITIONS ONLY LN YAM PPE EFERENCE
TYPE OF CONNEOTIOFROM
..(URLIL P.L LLENEN TGTH P.L
OWNERS PERt�rr $ 00
AUTHORaATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
OONTRACTOR TD CONNECT THE ABOVE DEWRIBED EXISTING APPROVALS IN9PECTOR'8SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF Iq_ NEW HOUSE SEWER S C
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP.PIT(8)
ADDRESS AMD OR DRA NFIELD
' HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- OESSPOOL I] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STAT[ LAWS ALTSR,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEIYAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE D IH D1RESIDENTIAL PROPERTY.
L PROPERTY. TANKS
BEEP.PIT(�� 0688O ❑
SIGNATURE
OF PERMITTEB�
TU543A 603 T/OS
COUNTY OF LOS ANGELES TEMPLE CITY 9 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0006270019
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER / SEPTIC: S BUILDING ADDRESS:
TR: 19338 LT: 8 EXIST OCC GRP: 6148 CAMELLIA AV
BLDGS. NOW ON LOT: TEMP CA 917801733
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: GARIBALDI
5385-017-014 ORIGINATION: THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: P'RES ON:
06/27/00 UT 2/24/00
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FIN.AL EIT: CODE:
LEE BOWMAN (626) 291-2353- JOB NUMBER: _
61Z� CAMELLIA AVE TRUNK PERMIT NUMBER:
TEMPLE CITY, CA ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO REPAIR SEWER LINE
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NR�gg RECORD DATE: SPEC�AL CONDITIONS:
HIGHWAY/STR�•VII ��l�tl
STATE ` � �ICONTRACTOR: TEL. K:
-`
-�-k-F�EESPAi APPROVALS DATE INSPE
SAME AS OWNER '���
LIC. NO f 6E POTION• QUANTITY. Lbi:,,,\ AMOUNT: N E61 HOUSE SEWER
01
IT ll E FE \ `,',�. 27.75
15 ALT7�t HOUSE' • 1.00 EA �� 30.45 BUIL ING OR WORK
ARCHITECT 5ramn : - r TOTAL SEES ``,\ 58.20
SEEPAGE PIT
LIC. I( a.11lllll 1 AND/0R DRAISEPTIC N
I
FIELD
UKTWtLL
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SEWER MAP BOOK: PAGE:
r_, �' � �4^ T -\ SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANbON HOUSE SEWER
(' 'r _
�i Ll - % SEEP. PIT _ CESSPOOL
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REPORT ID: DPR266 ROUTE TO BS0508