HomeMy Public PortalAbout5108, 5106 DALEVIEW AVE_Sewer__ APPLICATION FOR PERMIT
4&E863 356
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer -
County of Los Angeles SulLDING
WM.J. FOX, COUNTY ENGINEER
ADDRESS61
CASSATT D. GRIFFIN. SUPT of BuitvlNe LOCALITY A ti
FOR APPLICANT TO FILL IN caoss sr.
DESCRIPTION LOT NOT lac 2 n ► OWNER
BLOCK TRACT / MAIL
J ADDRESS
NO. OF BLOTS. "1 �—
SIZE
_ OF LOT NOW ON LOT ( CITY TEL. N0.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PG
CONTRACTOR
ADORES S ^ q I CONNECTION DATA
CITYQN TEL. NO. STATION DEPTH
lLl� il.� ❑ COUNTY MANHOLE REFERENCE
REGISTRATION N0. 0D
NO. DESCRIPTION OF WORK FEE
9•
TYPE OFNECTq,
,� ALENGTO FRLO FHOUSE SEWER CONNECTING TO L
PUBLIC SEWER Q $ 3.50 qq
Or
T HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR P. C. NO.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. JOB N0.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.001 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM 1.00 PERMIT N
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/Oft DRAT NFIELD 2.00 INDUSTRIAL
CESSPOOL- ORYWELL WASTE.APPROYAL
SPECIAL CONDITIONS ONLY 2.00 R
CONNECTION CoA FEE
OWNERS PERMIT S 00
AUTHORIZATION TOTAL FEE $ �A REIMBUR AIENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY PF - 19_ NEW HOUSE SEWER �o3
OWNER OR CONNECT ADDITIONAL
BUILDING OR WORK
OWNERS AGENT[ Q� _ (� � �p / / BUILDING
O/d J/Gi U�'�'♦' /A'/jt�¢L(p W^j- SEPTIC TANK, SEEP, PIT(S)
_ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED ANO/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPS TY. BACKFILL SEPTIC TANKS❑, jy L
* SEEP. PIT($) ❑ CESSPOOLS' 7
SIGNATURE
OF PERMITTEE -
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
.1 4 71OGT 1.8 4 5..50 m
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BE 0508 0401230002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 _
` PHONE: (626) 285-0488 EXT:
LEGAL D: SEWER / SEPTIC: SEWER -BUILDING ADDRESS:
TR: 14020 LT: 14 EXIST OCC GRP: - 5108 DALEVIEW AV
BLDGS. NOW ON LOT: TEMP CA 917803521
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: FREER
8574-007-014 ORIGINATION: THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY
LENGTHML TO PL: -STATION: DEPTH: - - - - " - - -
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
01/23/04 VG 07/21/04
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. N0: PLAN CHECK NUMBER: FINAL DATE i FINAL BY: CODE:
DOMINGA PRIETO MOREN08AL]CE C TAYLO (626) 444-9363- JOB NUMBER:
5108 DALEVIEW AVE TRUNK PERMIT NUMBER:
TEMPLE CITY 91780 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO ADDITIONAL WORK TO EXISTING HOUSE SEWER
WAIVER: NO ,
APPLICANT: TEL. NO: EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER
01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
13 WORK TO HOUSE SEWER 1.00 EAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. N0: TOTAL FEES 58.20
- SEPTIC TANK, SEEPAGE PIT
LIC. NO: AND/OR DRAIN FIELD
RYWELL
SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS _
SEEP. PIT CESSPOOL
RAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO BS0508