HomeMy Public PortalAbout5334 ENCINITA AVE_Sewer__ DEPAI&MENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING e/ Q!
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS 3 -,4 Ci%A )(7
FOR APPLIC T O FILL IN LOCALITYBUILDC,
NEAREST
ADD EISS Is-3 3 4 ,,� &/y)7',q/9�/e�, CROSS ST 'e, ,
LOCALITY paMP �� ��� i DISTRICT NO SERIAL NO PERMIT NO
NEAREST !" A S
CROSS ST e+ /�tl y RECEIVED BY Ready for Inspection DATE I UC+(, DD
OWNER Q.J�P,l ��`NN����40–
MAIL �� d�� BK PG USE ZONE OCCUPANCY MAP I
ADDRESS LSF
CITY TEL NO/09- � M
CONTRACTOR ( CO.IMP NO 13 7 l r/ir
ADDRESS ` JOB NO
CITY TEL NO TRUNK PERMIT NO
STATE
REGISTRATION NO a COUNTY' ROAD PERMIT NO
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 0 OF BL
?fXOW ON LOT
i CHARGES
USE OF ♦�'� ��'
BUILDINGS C'. CONNEC ARGE FEE
N DESCRIPTION OF WORK FEE
REIMBURSEMENT FE
� OUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 350 RECEIPT NO TE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSALSYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING NO I DATE I BY
SEWER OR DISPOSAL SYSTEM 1 00 _
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 - CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR I I
�q
PITS AND/OR DRAINFIELD 200 STATION �,i}' /.�0,3 DEPTH G,
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2 00 / MANHOLE,REFERENCE
7 U 6 UPPERS LOW-SR
TYPE OF CONNECTI LENGTH FROM
OWNERS PERMIT $ 1 00 Y CURB PL
ML TOP L
AUTHORIZATION I TOTAL FEE 5 I
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED '
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE D TE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS 1Z. DAY OF _ v �_ _I NEW HOUSE SEWER
OWNER OR �^ ! CONNECT ADDITIONAL
OWNERS AGENT t__ ' / C!v __._ _ BUILDING OR WORK
ADDRESS '57 (g/✓f C _ _ SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI-, CESSPOOL[:] DRYWELL I]
CA
TIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE,'
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM "PHRTY-.�
ERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY NTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT OWN-
ER OF THE ABOV DESCRIB D RE Do BACKFILL SEPTIC TANKS❑SIGNATURE SEEP PIT(S)[] CESSPOOLS y ZQOF PERMITTEE _ _ i
76A642A 663 7/53
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0107030003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: EW SE I SS:
TR 11492 LT: 22 BL: A EXIST OCC GRP: 5334 ENCINITA AV
BLDGS. NOW ON LOT: 22 TEMP CA 917803114
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: BLACKLEY
8590-001-026 ORIGINATION: THOMAS PAGE: 596 GRID• J4 LOCALITY: TEMPLE CITY
LENGTH ML TO PL. STATION: DEPTH:
TENANT MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON
07/03/01 UT 12/30/01
COUNTY IMPROVEMENT NUMBER
OWNER: TEL. NO: PLAN CHECK NUMBER: FlN DATE FINA CODE:
SALDIVAR, DANIEL (626) 614-1044- JOB NUMBER
5334 ENCINITA AV TRUNK PERMIT NUMBER
TEMP 917803114 ROAD PERMIT NUMBER DESCRIPTION
AFFADAVIT: NO CONNECT ADDITIONAL SEWER LINE FROM BATH TO EXISITNG HOUSE
WAIVER: NO SEWER LINE
APPLICANT: TEL. . EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR: RECORD DATE SPECIAL CONDITIONS-
HIGHWAY/STREET-WIDENING:--�
STATE ENCROACH(MVNT;�P�ERM�T`=N�."�R-:--,
CONTRACTOR: TEL. NO �F.EES'PAID AP ROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER LIC. NO FE/�� ® OUANTIT\��
UOM• AMOUNT R
?7 Ir
/ 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. NO: - ���� TOTAL FEES� 58 20 SEPTIC Nn-07GY-P-17
LIC. NO./ __ I 1111111 AND/OR DRAIN FIELD
� RWLL
SEWER MAP BOOK PAGE- ic (� �` � \��� ALTER, REPAIR, S R 0
M 54 � I� ��I' \ SEWAGE DISPOSAL SYSTEM
LN
DISCONNECT PLUG AND
---— -— - — ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKSO s� jwL SEEP. PIT CESSPOOL
GRAYWATER sysTEFF
son,ac�
REPORT ID: DPR266 ROUTE TO BS0508