HomeMy Public PortalAbout4509 FIESTA AVE_Sewer__ D
S&E-683 11.55 - APPLICATION FOR PERMIT 1
S&E-6
DIVISION OF BUILDING AND SAFETY . SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of LOS Angeles LDDLR
G �.^
JOHN A. LAMBIE, COUNTY ENGINEER SCASSATT D. GRIFFIN, SUPT OF BUILDING Y ,(J
i
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL 32— OWNER (�-
DESCRIPTION LOT N0.
MAIL
BLOCK TRACT 2_ 9 ADDRESS
t
N0. OF B CITY TEL. N0.
SIZE OF LOT NOW ON LOTOT
USE OF I
BUILDINGS DISTRICT N0. GROUP MAP
J BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
w L�
i� STATION DEPTH
'+ CITY iEL 0. —J MANHOLE REFERENCE UPPER
STATE LOWER
- REGISTRATION NO. D 7 4 ❑ COUNTY
NO. DESCRIPTION OFUUHK FEE TYPE OF CONN CION LE TH FROM
HOUSE SEWER CONNECTING TO r
PUBLIC SEWER @ $3.50 Y. CURB P.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. N0.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO.
HOUSE'SEWER CONNECTING TO a
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHM T
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE G1 G� INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPRO AL
CHAR S
CONNECTION CHARGE FEE -
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE p
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN KAMED CON- APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. ! NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT +'
SEPTIC TANK,SEEP,PITS)
ADDRESS - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND 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 j
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
x DESCRIBED RESIDENTIAL PRO ERTY. BACKFILL SEPTIC TANKS❑ _
SIGNATURE 7 ` SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE, COUNTY6tNGINEER VALIDATIO ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH I -
LAC03 9 NO AUG* 710 A 2.0 0 In
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 9811250002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (818) 285-0488 EXT:
LEGAL ID: SEWER / SEPTIC: X BUILDING ADDRESS:
TR: 12998 LT: 32 EXIST OCC GRP: 4509 FIESTA AV
BLDGS. NOW ON LOT: TEMP CA 917804210
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: LOWER AZUSA
8592-002-031 ORIGINATION: THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
_ LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
11/25/98 UT 11/25/99
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAI.. DATE FINAL BY:/f CODE:
LUNN MARIE M - JOB NUMBER:
4509 FIESTA AV TRUNK PERMIT NUMBER:
TEMP 917804210 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO SEWER CLEANOUT
_ WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO ,
GEORGE BRAZIL (310) 253-5229-
3801 LENAWEE AVE. RECORD INSTRUMENT NBR: - - RECORD DATE: SPECIAL CONDITIONS:
CULVER CITY, CA HIGHWAY/STREET,WI'DEN_ING :
STATE ENCROACHMENT�PERMIT`'NUMBER:
CONTRACTOR: TEL. NO: '�//� FEES"-PAI D'-:V APPROVALS DATE INSPECTOR SIGNATURE
GEORGE BRAZIL PLB HTG AND ELECT (310) 838-0408- cz°
3801 LENAWEE AVE LIC. NO FEEJDESCRIP-.TYON: ;� '�� QUANTITY: UOM: �\ AMOUNT: NEW HOUSE SEWER
CULVER CITY CA 90232 432734 C10 ,�1� w
01'PERMIT..ISSUANCE `FEE f� � '.• 27.75 CONNf:CT ADDITIONAL
13-WORK TO\HOUSE-SEWER`_,' 1.00 EAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. N0: — -TOTAL FEES`-, 58.20
SEPTIC TANK, SEEPAGE PIT
LIC. N0: ---— -i I i',lt}' AND/C,R DRAIN FIELD
DRYWE LL
SEWER MAP BOOK: PAGE: ALTEP, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANCON HOUSE SEWER
BACKFILL SEPTIC TANKS
SEEP, PIT _ CESSPOOL _
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO BS0508