HomeMy Public PortalAbout5205 DOREEN AVE_Sewer__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BE 0508 0609110003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER / SEPTIC: SEWER BUILDING ADDRESS:
TR: 11290 LT: 21 BL: C EXIST OCC GRP: 5205 DOREEN AV
BLOCS. NOW ON LOT: TEMP CA 917803441
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: FREER -
0585-023-035 ORIGINATION: THOMAS PAGE: 597 GRID: C4 LOCALITY: •TEMPLE CITY, C
LENGTH ML TO PL: STATION: DEPTH: I
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
09/11/06 SK 03/10/07
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DAT FIN - CODE:
PHAN, PETER (626) 215-7114- .TOB NUMBER: ^ J//.
5205 DOREEN AV TRUNK PERMIT NUMBER: (7/1�Y
TEMP 917803441 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO NEW 2ND: UNIT CONNECT TO PUBLIC SEWER
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
HINH XA (626) 625-B793-
9423 GUESS ST. RECORD INSTRUMENT HER: RECORD DATE: SPECIAL CONDITIONS:
ROSEMEAD CA 91]]0 HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO: _ FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
DING'S CONSTRUCTION SERVICE (626) 705-7246-
5917 OAK AVENUE #365 LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER
TEMPLE CITY, CA 91780 615060 B I -
O1 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
_ 03 CONN TO PUBLIC SEWER 1.00 CON 46.95 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. NO: TOTAL FEES 74.70
MEMO HSIEN WANG (626) 255-8595- SEPTIC TANK, SEEPAGE PIT
0748 VALLEY BLVD., F LIC. NO: _ AND/OR DRAIN FIELD
ROSEMEAD, CA 91770 C 043146
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
REPORT ID: DPR266 ROUTE TO BS0508 -
7BAS42D APPLICATION FOR PERMIT
S A E-663 I1.55
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Dep=tment of County Engineer
. County of Los Angeles eBILmnG _ _
JOHN A. LAMBIE, COUNTY.ENGINEER
® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY �jbly�p�•C _ l
FOR APPLICA'7NT TOu FILLLLEGAL
IN ceoss sr. '� t z l�
DESCRIPTION LOT NO. �( J • V+ V t O F OWNER -tF, +F �d [.O -
BLOCK TRACT ADDRESSNO. OF
SIZE OF LOTdax NOW ON LOTS CITYEL. N0
- -
.
USE OF �p
BUILDINGS RQ S O' V C DISTRICT NO. GROUP BK MAP PG
CONTRACTOR prIlpF
ADDRESS . Z, " W /gYJM... 0_171, 3
� /CONNECTION DATA
CITY k_4 AiE D 11ie �TEL. N f-yy `' s STATION a VT , 3 DEPTH
(� MANHOLE REFERENCE p 6 UPPER
REGISTRATION NO, �� 0 s�� COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
1 HOUSICE SSE WEE CONNECTING TO @ $3.50 J TYPE OF TION L.- LENGTH FROM vj�/
Y, CURB P. M.L.TOPUBL
SEPTIC TANK.SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD @ $3,00
OVERFLOW SEEPAGE PIT, DRAINFIELD CO. IMP. NO. �' JOB NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $'2.00.
HOUSE SEER
PRIVATE DISPOSAL SYSTEMG TO Q $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.9V`
CONNECT ADDITIONA LUG.04 STATE ENCROACHMENT
WORK TO HOUSE 5 • O PERMIT NO.
ALTER',REPAIR OR ABANDON HOUSE INDUSTRIAL , _
SEWER OR DISPOSAL SYSTEM _ (u $ 1.00 WASTE APPROVAL '
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT s -r DO
REIMBURSEMENT FEE
-
AUTHORIZATION TOTAL FEE
APPROVALS DATE INSPECTOR SSIGNATURE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. ` �/® NEW HOUSE SEWER'
SIGNED THIS / Y/,Q/p 'A/�^'`Q 1:f7' 'CONNECT ADDITIONAL.
OWNER ORBUILDING OR WORK
OWNERS AGENTw` SEPTIC TANK,SEEP, PHIS) -
ADDRESS�71%-d ' �'T-NB - AND/OR DRAINFIELD .
HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
ANO 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIREDLBY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER /
CALIFORNIA A OR THAT I THE LEG OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL OPERTY. BACKFILL SEPT IC TANKS El
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS e
OF PERMITTEE / r
JOHN A. LAMBIE. CTY ENGINEER -ALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. N.0. CASH '
02.0 : .A 550 ,�'