HomeMy Public PortalAbout5426 ENCINITA AVE_Sewer__ 3-E4
76A642D APPLICATION FOR PERMIT
6A64
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING `y^
JOHN A. LAMBIE, County Engineer ADDRESS �N
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAREST
FOR APPLICANT TO IFILL IN
LEAL �r CROSS ST.
DESCRIPTION LOT NO. 1' P13 "�J O OWNER
MAIL
BLOCK TRACT � � � �. ADDRESS �J
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO,
USE OF
BUILDINGS �) 4/4 DISTRICT NO. GROUP MAP PROCESSED BY
6e F/
BK PG
CONTRACTOR /V 7-
ADDRESS 6 CONNECTION DATA
CITY0. NO. STATION C r J DEPTH
1411 a STATE ���PPP PPE
REGISTRATION NO. 0 COUNTY MANHOLE REFERENCE
NO. 1 DESCRIPTION OF WORK FEE TYPE OF CO CTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. RB P.L. M.L.TO P.L.
PUBLIC SEWER @ $5.00
SEPTIC TANK,SEEPAGE PIT OR '7 P.C.NO.
(/��
PITS AND/OR DRAINFIELD CO.IMP. NO. JOB NO. CL
$10.00 O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.UIZU
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL 811971101- AFFIDAVIT I WAIVER I IIA9[M[NT RECORD.INSTR.NO. T
WORK TO HOUSE SEWER $3.00 (J C1 O
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE a $5.00 U
ALTER,REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING LU
0-
SEWU OR DISPOSAL SYSTEM @ $3.00 to
Q STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
C?fAMR's RMIT s 2 00
CONNECTION CHARGE FEE
AUT ORIZATI TOTAL FEE
'IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR T0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLISEWER. APPROVALS DATE INSPECTO 'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL /
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL Cl 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 DISPOSALSYSTEM
CALIFORNIA OR THAT 1 A THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOV SCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEW ER
SIGNATUREITTEE BACKFILL SEPTIC
OF PERMTANKS ❑ A
SEEP.PIT(S) ❑ CESSPOO LSZ 1,`{ 16
VALIDATION ROBERT A. WOOD
CK. M.O. CASH
SUPERVISING MECHANICAL ENGINEER
LAL;0 9 3 5 1- JUN 2 9 1 O D 10.00- 1-It
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SE-0508 9803260004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL ID: SEWER / SEPTIC: S BUILDING ADDRESS:
ON FILE EXIST OCC GRP: 05426-ENCINITA AVS
BLDGS. NOW ON LOT: TEMP-CA 9178031'16
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET:
8588-031-017 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:
03/26/98 UT 03/26/99
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
HUNG TUYET-PHI (818) 309-9931- JOB NUMBER: 2_Z''
5426 ENCINITA AV TRUNK PERMIT NUMBER:
TEMP 917803116 ROAD PERMIT NUMBER: DESGRIPTI'ON-OF-WORK-----�
AFFADAVIT: NO REPAIR-SEWER(DRAIN)-L-INE
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
SAX950*00WWR ^� le "- 30�i�-/llly� RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
(HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER: "
CONTRACTOR: TEL. NO: FEES'PAID, APPROVALS DATE INSPECTOR SIGNATURE
/y LIC. Nf FEE DESCRIPTION: QUANTITY: UOM: � AMOUNT: NEW HOUSE SEWER
IylJ3 ����� lvDo�o3 01 PERMIT ISSUANCE"/FEE - 27.75 CONNECT ADDITIONAL
15 ALT/REP HOUSESEWER1.00 EAC 30.30 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. N0: - TOTAL FEES 58.05
SEPTIC TANK, SEEPAGE PIT
LIC. NO: - AND/OR DRAIN FIELD
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