HomeMy Public PortalAbout5039 FIESTA AVE_Sewer__ E
8&E-663 9.55 APPLICATION FOR PERMIT
9 Bi EE
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Dep=tment of County Engineer
County of LOS Angeles AD'LDDRESSG ��_/
WM.J. FOX, COUNTY ENGINEER
F-` CASSATT D.GRIFFIN,SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST �I_
CROSS ST. ��i'-'�/
LEGAL /� ^
DESCRIPTION LOT N0. �p OWNER __
BLOCK TRACT J MAIL
T ADDRESS j - �
NO. OF BLDGS. z
SIZE OF LOT NOW ON LOT CITY TEL. NO.
7111
USE BUILDIDI NGS /y /J,� DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR Ir ( 1,
ADDRESS CONNECTION DATA
CITY TEL. NO. STATION DEPTH ,
MANHOLE REFERENC'c tD� al<'
REGISTRATION N0. 7 � �� ❑ COUNTY p�
NO. DESCRIPTION OF WORK FEE
TYPE 0 N CTION LENGTH FROM O
j HOUSE SEWER CONNECTING TO �-_ y� CURB - . M.L. TO P.L.
-E/—
PUBLIC SEWER Q $ 3.50 -
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR P. C. NO.
WORK TO HOUSE SEWER 1.00 _ CO. IMP. NO. ( JOB NO.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRU14K PERMIT NO. ROAD PERMIT NO.o®/
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 1300 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CIJARGE FEE
PERMIT OWNER'S $ 1 00
AUTHORIZATION I TOTAL FEE � REIMBURSEMENT FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPEC OR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS -DAY OF 19_ NEW HOUSE SEWER
CONNECT ADDITIONAL l
OWNER OR BUILDING OR WORK
OWNERS AGENT
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I0ACKNOWLEDGE THAT 1 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
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT IAM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER GG
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ /J M
SEEP:P17(S) ❑ CESSPOOLS '
SIGNATURE -1 `
OF PERMITTEE de
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF FLEG. INSPECTOR
LAC6 9 8 3 6 N SEP 4- 4 4„55 0 0
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0305160001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: S W SEPTIC: X BUIL G ADDRESS:
TR: 13329 LT: 49 BL: .001 EXIST OCC GRP: 5039 FIESTA AV
BLDGS. NOW ON LOT: TEMP CA 917803819
ASSESSOR INFORMATION U BER: CONNECTION TYPE: NEAREST CROSS STREET: LA ROSA
8590-019-009 ORIGINATION: THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED 0PROCESSED BY: EXPIRES ON:
05/16/03 JK 11/12/03
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATEFINAL BY: CODE:
MONROE ORA GATES (626) 285-7096- JOB NUMBER:
5039 FIESTA AV TRUNK PERMIT NUMBER: �_Z� �_
TEMP 917803819 ROAD PERMIT NUMBER: DESC PT ON OF WORK
AFFADAVIT: NO REPLACE SEWER LINE
WAIVER: NO
APPLICANT: TEL. 0: EASEMENT: NO
CLARK'S AND GEORGE'S PLUMBING (626) 573-2107-
9233 RIO DELL ST RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
ROSEMEAD HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
CLARK'S AND GEORGE'S PLUMBING (626) 573-2107-
9233 RIO DELL LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER
ROSEMEAD CA 91770 748881 C36
01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
15 ALT/REP HOUSE SEWER 1.00 EAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. NO: TOTAL FEES 58.20
SEPTIC TANK, SEEPAGE PIT
LIC. NO: AND/OR DRAIN FIELD
DRYWEL
SEWER MAP BOOK: PAGE: ALTER REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
797 f;-t4 C'. U
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFI L SEPTIC TANKS _
SEEP. PIT CESSPOOL
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO BS0508