HomeMy Public PortalAbout10637 DAINES DR_Sewer__ 6A642 0-63 APPLICATION FOR PER
C E808 1
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE. County Engineer ADDRESS
WILLIAM A. JENSEN, Supt o1 Building
LOCA
NEAREST
FOR 1}P�L C N 1 FILL IN 2 �./ `R°B3 3T. 41
LEGAL
DESCRIPTION LOT NO.
MAIL
BLOCK TRACT _ , (. ADDRESS
NO. OFSLOGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
f BN PG o
CONTRACTOR Jg
ADDRESS - CONNECTIO/(N DATAC;r
/A STATION DEPTH
CITY TEL. NO ❑i ,,/J
REGISTRATION NO. O ❑ COUNTY STATE MANHOLE R EFEHENCE y UPnwvo
NO. DESCRIPTION OF WORK E TYPE OF CONNECTIO LENGTH FROM L.
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER a moo d
P.C.NO.
PITS ND/OR GRAINFIELD T OR ® SIO.00 CO.IMP.NO. JOB NO, O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00 W
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT 45[v[xi RECORD. INBTR.NO. DATE O
WORK TO HOUSE SEWER ® $3.00 0
OVERFLOW SEEPAGE PIT.DRAINFIELD "' r W
EXTN.,CESSPOOL.DRYWELL.MA NHO LE a SS
.00 y
ALTER.REPAIR OR ABANDON HOUSE0R E IND Z
SEWER OR DISPOSAL SYSTEM ® E3.00 STATE ENCROACHMENT —
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT s z 00 CHARGES
AUTHORIZATION TOTAL FEE ' CONNECTION CHARGE FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER. DATE INSPECTORB SIGNATURE
SIGNED THIS DAY�F 19_
OWNER OR //'[[ NEW HOUSE SEWER
OWNERS AGENT �E(1 11
CONNECT ADDITIONAL 'V(
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP.PITIS)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ANO/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
L IC ENSE0AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOV DEBCRI O BIOENTIAL P OPER Y. ABANDON HOUSE SEWER
SIGNATURE J _ Bq CKFILL SEPTIC TANKS ElOF PERMITTEE P BEEP, IT
ISI ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER
LA,0 7 9 7 2122 JAN 2 8 1 0 D 5.00-
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SE 0508 9704150001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL ID: SEWER / SEPTIC: SEWER IBUI LDING ADDRESS:
ON FILE EXIST OCC GRP: ` 10637 DAINES DR
BLDGS. NOW ON LOT: .TEMP CA 917802815
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: EL MONTE
8586-010-047 ORIGINATION: THOMAS PAGE: 597 GRID: C3 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION:TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: IRES ON:
/COUNTY IMPROVEMENT NUMBER: 04/15/97 LC 04/15/98
OWNER: TEL. N0: PLAN CHECK NUMBER: FINAL DATE FINAV Y: CODE: '
YANG JAMES;RAMONA - JOB NUMBER: 4-'t �
/n
10637 DAINES DR TRUNK PERMIT NUMBER: �/
TEMP 917802815 ROAD PERMIT NUMBER: DESCRIPTION U� OLTP'
AFFADAVIT: NO ON-SITE HOUSE SEWER REPAIR
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
RAPID PLUMBING, INC. (800) 834-5222-
RECORD INSTRUMENTINBRRECORD-DATE: �S SPECIAL CONDITIONS:
STATEAENCROACHMENT,TEPERMIT NUMBER:
'OJ // '"\\ n \\\\\\ a
CONTRACTOR: TEL. NO: ]yr �rr FEESPAID APPROVALS DATE INSPECTOR SIGNATURE
RAPID PLUMBING, INC. (800) 834-5222- �{�; / i�l' +} �\ ,� ? \\\k -
1746 ABALONE ST LIC. NO FEE DESCRIPTION�•I ��•� QUANTITY: UOMP AMOUNT:: N HOUSE SEWER
TORRANCE CA 90501 C36 * I. •• T" -� -�-`
01 PERMIT ISSUANCE-FEE---'r❑�-y---- ---��ff27:75 CONNECT ADDITIONAL
15 ALT/REP HOUSE,SEWER ,��� 11'1004EACI__ E 30 i30 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. NO: c=-J Ou TOTAL FEES0/J8 L J 58.05
_ r — SEPfi C
-W, SEEPAGE PIT
LIC. NO: I I � I� AND/OR DRAIN FIELD
_ -
DRYWELL
SEWER MAP BOOK: PAGE: _ ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND -
CCYY ABANDON HOUSE SEWER
�9
BACKFILL SEPTIC TANKS
S3S � SEEP. PIT _ CESSPOOL
tl GRAYWA S STEM
* ADDITIONAL DATA ON FILE
REPORT ID: DPR266 ROUTE TO BS0508