HomeMy Public PortalAbout9053 EMPEROR AVE_Sewer__ T
CE608 5-65
7 6A 642 D APPLICATION FOR PE MIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A LANIBIL County I ngtnecr ADDRESS
COLEMAN W JLNKl\S Sup't of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN `ROSS ST
LEGAL
DESCRIPTION LOT NO� ! OWNER
MAIL
BLOCK TR C ADDRESS
N OF BLOGS
SIZE OF LOT W ON LOT CITY TEL NO
USE OFDISTRICT NO GROUP MAP PROCESSED BY
BUILDINGS
BK PG
CONTRALTO 5-,, 00ff
ADDRESS
CONNECTION DATA
CITY TEL NO ,� STATION a DEPTH
LICENSE LICENSE J MANHOLE REFERENCE �C� UPPER
NO CLASS Z �l WER
NO ESCRIPTI OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB L M L TO P L .�
PUBLIC SEWER C $ 5 00
S PTI1:� 5E AGE PIT OR PC NO 9L
PITS AND/OR DRAINFIELD C $10 00 CO IMP NO JOB NO O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO U
PRIVATE DISPOSAL SYSTEM F $ 3 00
CONNECT ADDITIONAL BLDG OR AFFIDAVIT wA1vER [ASEMCNi RECORD INSTR NO DATE
WORK TO HOUSE SEWER C' $ 3 O
00 0
A E ABAN N HOUSE U
SEWER OR DISPOSAL SYSTEM C $ 3 00 W
HWY ORST WIDENING d
E%TN CESSPOOL MANHOLE @ $ 5 00 h
STATE ENCROACHMENT a
PERCOLATION TEST @ $ 5 00 PERMIT NO
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT s 2 00
AUTHORIZATION TOTAL FEE O� CONNECTION CHARGE FEE
ITHAVE AT THIS DATE A CONTRACT WIH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC 5EWER APPROVALS DATE INSPE5TOR S SIGNAT RE
SIGNED THIS DAY OF
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
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 DISCONNECT PLUG AND
RESIDE IN THE AB VE DESCRIBED RESIDENT AL PROP TY ABANDON HOUSE SEWER ,{
SIGNATURE BACKFILL SEPTIC TANKS ❑ I Q j
OF PERMITTE _ (�
SEEP PIT(S) ❑ CESSPOOLS
(5 - C)
ALIDATION
CK M O CASH
0
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEW ERRiPERM IT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SE=0508_9811040001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 t _
PHONE: (818) 285-0488 EXT:
LEGAL SE / SEPTIC- S BUILDING TDDRESS_-_
ON FILE EXIST OCC GRP: 9053FEMPERORsAV -
BLDGS NOW ON LOT: SGAB�-0)"917752016
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE. NEAREST CROSS STREET ROSEMEAD
5382-011-013 ORIGINATION: THOMAS PAGE. 596 GRID: H1 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED D B PIRES 0
11/04/98 UT 11 4/99
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY- CODE:
ONAMI MAYUMI JOB NUMBER: 7�r
9053 EMPEROR AV TRUNK PERMIT NUMBER:
SGAB 917752016 ROAD PERMIT NUMBER, M—CR-ITTION_0_
AFFADAVIT: NO CONNECT NEW-BATHROOM (2ND_BAT HR OM)`TO PUBLIC-SEWER__
WAIVER: NO
APPLICANT- TEL. NO. EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR: RECORD DATE. SPECIAL CONDITIONS.
HIGHWAY/STREET,WIDENING:
STATE ENCROACHMENT`PERMIJT•LNUMBER:
SAME
RASTOWNER TEL. NO FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
LIC. NO FEE��SIR1�TION: QUANTITY: UOM: AMOUNT. NEW HOUSE
01/PERMIT✓f SSUANCE FSEE 27.75 CONNECT ADDITIONAL
13 WORK TO HOUSE-SEWER 1.00 EAC 30.45 BUILDING OR WORK
ARCHITECTENGINEER: 0: TOTAL FEES 58.20
SEPTIC TANK, SEEPAGE
LIC. NO 1111111 AND/CR DRAIN FIELD
DRYWELL
SEW R MAP BOOK. PAGE: RUC�C Tj O�K S ALTER, REPAIR, SEWER OR
IP U Q �I SEWAGE DISPOSAL SYSTEM
1 DISCON G AND
D 0 ABANDON HOUSE SEWER
*.
BACKFILL SEPTIC TANKS _
0 O _>f SEEP. PIT _ CESSPOOL _
GRA WATER SYSTEM
REPORT ID: DPR266 ROUTE TO SS0508