HomeMy Public PortalAbout9802 DAINES DR_Sewer__ ' r
CE8083 62 APPLICATION FOR PERMI
78A842D COUNTY OF LOS ANGELES
SEWER—SEWAGE DISP AL.
DEPARTMENT OF COUNTY ENGINEER LLLIII
BUILDING AND SAFETY DIVISION BUILDING Q ��
JOHN A LAMBIE, County Engineer ADDRESS
21
WILLIAM A JENSEN, Supt of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN `ROSS 5T
LEGAL
DESCRIPTION LOT NO 7 - OWNER
MAIL
BLOCK TRACT A ADDRESS
NO OF BLDG$
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF n -
BUILDINGS DISTRICT NO GROUP MAPPROCES BY
' BK PG
CONTRACTOR
ADDRESS (,(f COD LTA
t �O STATION DEPTH '
CITY TEL Id
STATE MANHOLE REFERENCE PPER
REGISTRATION NO O`,�S COUNTY
NO DESCRIPTION OF WORK FEE TYPE OFC ION LENGTOM (� t
HOUSE SEWER CONNECTING TO ,}..�� Y CURB P L M L TOP T
PUBLIC SEWER @ $5 00 (J(/
PC NO
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $1000 Co IMP NO JOB NO n V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT 1 A.
PRIVATE DISPOSAL SYSTEM @ $300
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER l�SEMENT RECORD INSTR NO DATE
WORK TO HOUSE SEWER @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $5 00
ALTER REPAIR OR ABANDON HOUSE HWY ORST WIDENING
SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT $ i 00 CHARGES
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE (f(7
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEW APPROVALS DATE INSPECTOR S SIGNATURE
SIGNED THIS 4DAY-OF- 19�
OWNER OR NEW HOUSE SEWER
OWNERS AGENT_ _ CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK F
SEPTIC TANKSEEP PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD ���e
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL [3DRYW ELL ❑
PLUMBING AND SEWERS
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR V /
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO •y
RESIDE IN THE ABOVE ESCRI BED RESIDENTIAL PROPERTY DISCONNECT PLUG AND
ABANDON HOUSE SEWER �a 0
SIGNATUREBACKFILL SEPTIC TANKS ❑
OF PERMITTEE _.� T1C lA � ❑
SEEP PIT(S) ❑ CESSPOOLS
VALIDATION ROBERT A WOOD
CK M o CASH SUPERVISING MECHANICAL ENGINEER
LAL-,'o 6 8 7 6 NOV 1 3 1 0 D 7.0 O N �
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1302270006 _
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 -
PHONE (626) 285-0488 EXT
(LEGAL ID ISEWER / SEPTIC SEWER BUILDING ADDRESS
ITR 13805 LT 73 IEXIST OCC GRP 9802 DAINES DR
IBLDGS NOW ON LOT 1 TEMP CA 917802636
(ASSESSOR INFORMATION NUMBER ICONNECTION TYPE I NEAREST CROSS STREET GOLDEN WEST
18588-017-010 (ORIGINATION i THOMAS PAGE 597 GRID A3 LOCALITY TEMPLE CITY CAI
I ILENGTH NII, TO PL STATION DEPTH
ITENANT IMANHOLE REFERENCE UPPER/LOWER (ISSUED ON PROCESSED BY
1 102/27/13 SR
ICOUNTY IMPROVEMENT NUMBER I
(OWNER TEL NO (PLAN CHECK NUMBER IFINAL DAT FINAL BA CODE
ICHEN, SARA (626) 292-7087- (JOB NUMBER
19802 DAINES DR ITRUNK,PERMIT NUMBER
ITEMP 917802636 _ IROAD PERMIT NUMBER _ IDE CRIPTION OF WORK
I IAFFADAVIT NO - ISEWER LINE REPAIR -
I IWAIVER NO I -
JAPPLICANT TEL NO 1EASEMENT NO I
TRIOS, RICO (626) 358-1490- 1 1
IPO BOX 407 IRECORD INSTRUMENT NBR RECORD DATE _ ISPECIAL.CONDITIONS
IMONROVIA CA 91017 (HIGHWAY/STREET WIDENING -
ISTATE ENCROACHMENT PERMIT NUMBER s *'
I I �-
(CONTRACTOR TEL NO- FEES PAID (APPROVALS - DATE INSPECTOR SIGNATURE
IRUDY'S PLUMBING (626) 358-1490- -
IP 0 BOX 407 - LIC NO IFEE DESCRIPTION QUANTITY UOM AMOUNT INEW HOUSE SEWER I- I
(MONROVIA CA 91016 917340 1 _ 1— I I I
101 PERMIT ISSUANCE FEE 27 80 ICONNECT ADDITIONAL I I
1 115 ALT/REP HOUSE SEWER 1 00 EAC 30 50 IBUILDING OR WORK 1
1ARCHITECT OR ENGINEER TEL NO TOTAL FEES 58 30 1
I - ISEPTIC TANK, SEEPAGE PITI I
I LIC NO I IAND/,OR DRAIN FIELD I
DRYWELL 1 1
1
SEWER MAP BOOK PAGE _ (ALTER, REPAIR, SEWER OR I
ISEWA3E DISPOSAL SYSTEM 1 -
IDISCONNECT PLUG AND
1ABANDON HOUSE SEWER II
1 f IBACKFILL SEPTIC TANKS _I
1 1 ISEEP PIT _ CESSPOOL
I GRAY14ATER SYSTEM I I
I I II I II 11
I I I I I I
I I I I I I
I (REPORT ID DPR266 ROUTE TO BS0508 I
I I I I I I