HomeMy Public PortalAbout9898, 9828 FLAHERTY ST_Sewer__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1108170003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: ISEWER / SEPTIC: SEWER BUILDING ADDRESS: 1
ITR: 14063 LT. 12 (EXIST OCC GRP: ( 9828 FLAHERTY ST 1
1 IBLDGS. NOW ON LOT: TEMP CA 917801710 1
(ASSESSOR INFORMATION NUMBER. (CONNECTION TYPE- NEAREST CROSS STREET- 1
15365-026-025 (ORIGINATION: THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, Cl
' I ILENGTH ML TO PL: STATION: DEPTH: I
(TENANT. IMANHOLE REFERENCE: UPPER/LOWER: 11SSUED ON. PROCESSED BY: 1
I 108/1'7/11 SR 1
1 ICOUNTY IMPROVEMENT NUMBER: I
(OWNER: TEL. NO: IPLAN CHECK NUMBER: (FINAL ATE FILIAL CODE: 1
ILIU, PAUL (626) 274-7384- 1JOB NUMBER: 1 �(�
16159 CAMELLIA AVE. ITRUNK PERMIT NUMBER:
(TEMP 917801710 IROAD PERMIT NUMBER: lEfESCRIPTION OF WORK 1
1 IAFFADAVIT: NO ICONNECT NEW SINGLE FAMILY HOUSE TO PUBLIC SEWER
I (WAIVER NO I
(APPLICANT: TEL. NO: (EASEMENT: NO I
ILAI, KAMEN (626) 288-2657- 1 1
18748 E. VALLEY BLVD. IRECORD INSTRUMENT NBR: RECORD DATE: 1SPEC'AL CONDITIONS. 1
IROSEMEAD, CA 91770 1HIGHWAY/STREET WIDENING: 1
I ISTATE ENCROACHMENT PERMIT NUMBER:
I i I I
1CONTRACTOR: TEL. NO: I FEES PAID 1APPROVALS DATE INSPECTOR SIGNATURE 1
1PLC CONSTRUCTION INC. (626) 274-7384- 1 1 I
16159 CAMELLIA AVENUE LIC. NO IFEE DESCRIPTION: QUANTITY- UOM: AMOUNT: INEW HOUSE SEWER 1
ITEMPLE CITY, CA 91780 944538 B I I I
I 101 PERMIT ISSUANCE FEE 27.80 1CONNECT ADDITIONAL 1
I 103 CONN TO PUBLIC SEWER 1.00 CON 47.00 IBUILDING OR WORK 1 I
1ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 74.80 1 I I
(LEE, PETER (626) 280-9000- 1 ISEPTIC TANK, SEEPAGE PITI I 1
18748 E. VALLEY BLVD SUITE L LIC NO: I1AND/OR DRAIN FIELD I I I
IROSEMEAD, CA 91770 944538 B * I I I I
I I IDRYWELL
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I SEWER MAP BOOK: PAGE: I 1ALTEH, REPAIR, SEWER OR I I
1 (SEWAGE DISPOSAL SYSTEM 1 1 I
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IDISCONNECT PLUG AND I
I 1 (ABANDON HOUSE SEWER I I I
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BACKFILL SEPTIC TANKS _I
ISEEP PIT _ CESSPOOL
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* ADDITIONAL DATA ON FILE
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I APPLICATION FOR
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-,76A666 Ll p■ !ICATION ■ O■ Y PERMIT
1« 5&E 663 I-"�
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer _/ 9-4-
A—T
County of Los Angeles BUILDING �6.ADDRESS
WM J FOX, COUNTY ENGINEER -CASSATT D GRIFFIN SUP TOF BUILDING LOCALITYFOR APPLICANT TO FILL IN NEARESTCROSS ST
LEGAL DESCRIPTION LOT NO OWNER R.BLOCK TRACT / MAIL ���� ADDRESSSIZE OF LOT // r NOWOONBLOTS CITY E NOv14
USE OF
BUILDINGS ty DISTRICT NO GROUP MAP PG
CONTRACTOR e 3 t
ADDRESS ,�,� ', CONNECTION DATA
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CITY L STATION DEPTH
-'STATE I y� O MANHOLE REFERENCE
REGISTRATION NO/ +� of LOWER
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_ - TYPE OF CONNECTION LENGTH FROM
NO DESCRIPTION OF WORK FEE Y�� cOwe *%* M L To P LL
PHOUSE SEWER UBLIC SEWER CONNECTING TO @ $ 3 50IIiK/��� /� g�gf"'� �A wd`
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 100 ,
CONNECT ADDITIONAL BLDG OR CO IMP NO JOB NO �f'9
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING `
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO .ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK SEEPAGE PIT OR
ITS AND/OR GRAINFIELD 2 00 INDUSTRIAL
_
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT $ 1 00
AUTHORIZATION I TOTAL FEE .rU REIMBURSEMENT FEE
1
TRACTORHAVE T TO CONN ECTHIS DATE ONTRTHEAABOVE DESCR BEDCTED WITH THE HEREXISTINGA DWELLING G CONIj APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS "'DA O 19.J� NEW HOUSE SEWER 3-2 45
OWNER OR CONNECT ADDITIONAL _ YYXX
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK SEEP, PIT(S)
_ADDRESS ZJ '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 E'ALTER REPAIR,SEWER OR
PLUMBING AND SEWERS WAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SEEP PlT(S) ❑ CESSPOOLS T-1 SIGNATURE 1
OF PERMITTEE
WILLIAM J FOX, COUNTY ENGINEERI
VALIDATION
BY 4 4.50BY
DEPUTY, _ �' p 1� DEPUTY
BY BY �f
�`® DEPUTY �' ` Uof �{�}� DEPUTY