HomeMy Public PortalAbout9701 CRAIGLEE ST_Sewer__ 42D
CE80APP
P tl 1� �C K n O N FOR p R kl V 11�T
seoa a-sa COUNTY OF LOS ANGELES SEWER—SEWAGE DOSPOSAL
u`I
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JADDRESSJOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITYNEAREST '
FOR APPLICA�[T TO FILL IN CROSS sr.
R LEGAL
DESCRIPTION LOT NO. {f OWNER __ /
BLOCK TRACT MAIL Lj
ADDRESS `
NO.OF BLDGS.
SIZE OF LOT NOW ON LOTcity NO.
NO.
USE OF -_. . ,w,..... �.
BUILDINGS �. DISTRICT NO. GROUP MAP EAW4SSED BY
`� / BK PG01
I
CONTRACTOR yJam. ------------ �
+; ADRESSCONNECTION DATA
CITYTEL.NO. STATION DEPTH
ST&E MANHOLE REFERENCE UPPER
? REGISTRATION 0. j COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER - @ $3.00 TYPE OF CON
L GTH FROM
SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L. .L.TO P.L.
PI LD @ $3.00 ),
& OVERFLOW SEEPAGE PI ,DRAINFIELD -
ELL @ $2.00 1;
a HOUSE SEWER CONNECTING TO CO.IMP. N0. JOB N0,
PRIVATE DISPOSAL SYSTEM @ $1.00
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO NO PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
.p ALTER,REPAIR OR ABANDON HOUSE STATE ENCR ejMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 i PERMIT N0.
INDUST PkA L -
¢ WASTE PPROVAL
CHARGES
OVIMR'S PERMIT § 2 00 CONNECTION CHARGE FEE,
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
DATE A CONTRACT WITH THE` MED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIISTIINGADWELLING j APPROVALS. DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. _
SIGNED.THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR - CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
.AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ki
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO]BOVE
CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULAALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED ANDISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATABANDON HOUSE SEWER
CALIFORNIA OR THAT AM T L OWNER OF THE
DESCRIBED RESIDEN L ROPE BACKFILL SEPTIC TANKS ❑ -
\ SEEP. PIT( E ❑ CESSPOOLS ❑
SIGNATURE
OF PERMITTE
OF v
ALIDATION ROBERT A. WOOD
c1
M.0. CASH SUPERVISING MECHANICAL ENGINEER
LFIL'o 3.4 0 6 i4+, 6 o 4..0 0-
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER.PERMIT
_ DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0403300020
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER / SEPTIC: SEWER BUILDING ADDRESS:
ON FILE EXIST OCC GRP: R3 9701 CRAIGLEE ST
BLDGS. NOW ON LOT: TEMP CA 917801413
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: BARELA
5383-018-009 ORIGINATION: THOMAS PAGE: 597 GRID: Al LOCALITY: TEMPLE CITY, C
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
03/30/04 VG 09/26/04
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: PC NO.02-6 FINAL DATE FINAL BY: CODE:
GARCIA ARNOLD C;THELMA M (626) 285-0029- JOB NUMBER: }��Q
9701 CRAIGLEE ST TRUNK PERMIT NUMBER:
TEMP 917801413 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO CONNECT EXISTING RESIDENCE TO PUBLIC SEWER
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
GRBAVAC (626) 355-1350-
RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
GRBAVAC, MLADEN (626) 355-1350-
P. 0. BOX 660219 LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER
ARCADIA, CA 91006 364584 C42 *
01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITiONAI
03 CONN TO PUBLIC SEWER 1.00 CON 46.95 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. NO: 29 DISCON/ABANDN SEPTIC 1.00 SYS 30.45
TOTAL FEES 105.15 SEPTIC TANK, SEEPAGE PIT
LIC. NO: AND/OR DRAIN FIELD
DRYWELL
SEWER MAP BOOK: PAGE: ALTER,'REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS _
SEEP. PIT CESSPOOL
GRAYWATER SYSTEM
* ADDITIONAL DATA ON FILE
REPORT ID: DPR266 ROUTE TO BS0508