HomeMy Public PortalAbout5231 ENCINITA AVE_Sewer__ • 24650 INSERTS, ��-r •,
.80 APPLICATION-TOR PERMIT 1
r76AG428A842D COUNTY OF LOS ANGELES i
SEWER-SEWAGE,.DISPOSAL,,.; . 1•_ t
DEPARTMENT OF COUNTY,ENGINEER
BUILDING AND SAFETY DIVISION BUILDING _
'ADDRESS.
JOHN A LAMBIE County Engineer
WILLIAM A. JENSEN,
Sup
t of Building LOCALITY i
FOR APPLIC' ceoss sT.
LEGAL OWNER - r= ig,
DESCRIPTION, LOT N0. - '
BLOCK, TRACT V AMAIL DDRESS -'
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT N0. GROUP BK PG MAP P OCESSED BY
CONTRACTORNO-
ADDRESS 11) ( cfY, Ij CONNECTION DATA - -
CITY TEL.NO. STATIONAL= DEPTH
VR
STAT MANHOLE REFERENCE r'J UPPER-
REGISTRATIQ NO. v COUNTY - - LOWER
NO. I DESCRIPTION OF ORK I FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00 f
&& TYPE OF CTION LENGTH FROM
PITS AND/OR SEPTIC DRAINFGELDT OR @ $3 00 Y. UR P.L. M.L.TO P.L. '
OVERFLOW SEEPAGE PIT, DRAINFIELD '
EXTN CESSPOOL DRYWELL @ $2 00
HOUSE SEWER CONNECTING TO P.C.NO. -
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP. N0. JOB NO.
CONNECT ADDITIONAL BLDG.ORTRUNK PERMIT NO. ROAD PERMIT NO. 2 71177 O
WORK TO HOUSE SEWER` @ $1 00 r V -
ALTER, REPAIRORABANDON HOUSE STATE ENCROACHMENT to
SEWER OR DISPOSAL SYSTEM @ $100 •PERMIT NO- O
INDUSTRIAL •' F"
WASTE APPROVAL W
CHARGES tan
OWNERS PERMIT $ 2 1 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE _
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBE EXISTING DWELLING APPROVALS DATE INSPECTOR'S-SIGNATURE
TO THE PUBLIC S
SIGNED THISDAY OF 19 NEW HOUSE SEWEROWNER OR ��j /h'L ".r���Y/F✓,
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS — SEPTIC TANK,SEEP.PIT(S)
_ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE,READ THIS APPLICATION•• p• --- - - 77
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑, DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS 'ALTER,REPAIR,SEWER OR _
SEWAGE DISPOSAL SYSTEM ~
1 HEREBY CERTIFY THAT- 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED LOS ANGELES OUNTY AND STATE OF ABANDON DISCONNECT
HOUSE D
CALIFORNIA OR THAT A THE LE AL WNER $f' THE A VE
DESCRIBED RESIj�ENTI P PERT BACKFILL SEPTIC TANKS ❑ -
SIGNATURE -
SEEP.PIT(S) ❑ CESSPOOLS ❑
OF PERMII_,
O7/111, VATION ROBERT A. WOOD
Y.o. 'CASH SUPERVISING MECHANICAL,ENGINEER
i 4
_, . .__• L
6,O'r Z 77` DEC 12.1__O .o 5.'0.0,
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0307310003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER / SEPTff7r___ - BUILDING ADDRESS:
ON FILE EXIST OCC GRP: 5231 ENCINITA AV
BLDGS. NOW ON LOT: TEMP CA 917803134
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: BLACKLEY
5388-008-018 ORIGINATION: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
MANHOLE REFERENCE: UPPER/LOWER: .
07/31/03 JK 01/27/04
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL CODE:
CHAN;CANNY (626) 286-9786- JOB NUMBER:
5231 ENCINITA AVE TRUNK PERMIT NUMBER: _ I a
TEMPLE CITY, CA ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO CONNECT NEW SFR TO SEWER
WAIVER: NO
APPLICANT: EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET.WIDENING:
STATE ENCROACHMENT-PERMIT-NUMBER:
CONTRACTOR. TEL. 0: �z,\ S-PAID APPROVALS INSPECTOR GNATUR
SAME AS OWNERl,'
LIC. NO FEE'DESCRIPTION OUANTITY4"UOM: AMOUNT: NEW SEWER
01 PERMIT ISSUANCE FEE o 27.75 CONNECT DDITIONAL
03 CONN TOj PUBLEIC SEWER- 1.00 46.95 BUILDING OR WORK
ARCHITECT OR ENGINEER: % � ' �--- 1�-'_ fOTAL\FEES V� 74.70
PETER LEE ENGINEERING (626) 280-90001-
8748
80-9000 "" SE
8748 VALLEY BL. STE. L LIC. NOd �I_� I i AND/OR DRAIN FIELD
ROSEMEAD, CA 91°T70 NONE )fir i l I j ( ' ',I111��1
I l i DRYWELL
SEWER MAP BOOK: P _ , -_� ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
- _ ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS
SEEP. PIT _ CESSPOOL _
GRAYWATER SYSTER-
REPORT ID: DPR266 ROUTE TO BS0508