HomeMy Public PortalAbout9422 GARIBALDI AVE_Sewer__ r"
76A" '
a 8�6 ~ APPLICATION F :7) E
RMIT .
SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICANT TO FILL IN 1) ni]cT IND, QROUP BK MAF a RSSID EY
PG •, �-
.UILDINO X-3 N 7
ADDRlfs
Temple City CQNNECTtON DATA
NEAREST
STATION0 DETT'Ff I .
CNOSS
ST. b
MANHOLE RE rZ-RLNCi ! Lpwff R
OWNER TYrB Or LENGTH r}tem
MARIADC4tK" same Y. LJ11e PJ_ YL TO P.L -
P.C,NO.
CO-RMP.NO. JOB NO. . ..
CIT' TEL NO.
LL..��6w TRUNK MRM IT NO. ROAD MRM rT N0-
DESC:=.N LOT NO.
APFl DAVR I WAIVER EAUN a MT RECORD.ItSTR NO. DATE
.LOCK TRACT
WO.OP aL.DG6.
fm or LOT NOW ON LAT FIWY.OR ST.WED EN Iq
EUEG..D IiGSZe$i�• STATE ENCROACHMeNT
Universal
IT NO,
COffTRAGTOM Universal Pl b o A I t R AL•
D
ADRESD 2631 Lee Ave. CHARGES
C" Manta--.
CONNECTIONCHARGE
FEE
TATEp
I—,N 6018CLAS_SIrj RSYOURsa ENT FEE
LICE NS!
NO. DHSCR)PT10N OF WORK FEB APPROVALS DATE rNSMCrOR's fIGr ATlu
HOUR OW"R CONNECTING TO .
PUELIC SEvill n
SEPTIC TANK,SEEPAGe PIT OR NEW HOUSe SEWER
PICS AND/OR DRAT NPIALD C 3-NNECTADDrrLONAL
House SEWER CONNeCTwa TO ■ULDIFNO OR WOR% .
PWVATS DISPOSAL SYYTSM
SKPTIC TANK L�)
PEEP,rIT
CONNECT ADD BLDG.OR AND/On DRAINFlELD.
-WORK TO HOUSE '
070
ova RPLOWt so EPAGa PIT.DnALNrIe{{..DD CLSSPOOL ❑ DRYWeL L❑
ClSSP00 MANHbLE
ALTERAJM Oft ABANDON HQUSE ALTER,nEPAIR.f R OR
S EMlER PLOPOSAL SYfrRM BeWAGE D'8p^i ;=M
DtsCO"KCT PLUG AND - -
ABANDON HOUSE SEWER
nACKF&LL SEPTIC TANKS❑ -
S■EP.Fffl6)E3 Cass POO La[IOWNER'S Permit s
AUTHORIZATION TOTAL FEE V IDA N # o o O'O 1 0
I FLAVE AT THtf DATE A CONTRACT WITH THE HERRIN NAMED CON- `l r P ��
TRACTOR TO CONNECT THE ABOVE DESCRIBED R/ J'43 . 2 - - 1 � 00
TO TH E Pu eLiC Sawn R.
WGNEDTHL9 DAY OF 0,0 O 1 4. 0 0 6
OWNER OR
OWN.Rf AGHHT - - -1 1.20-79
ADDRESS
I HeREBY ACKNOWLEDGE THAT I HAVE MEAD THIS APPLICATION
AND STATE THAT THE ASOVE IS CORRECT AND AGREE TO COMPLY
WrrH ALL COUNTY ORDI/ANCiS AND STATE LAWS REGULATING
PLUMSING AND EEWERS-
I HERESY CERTIFY THAT I PROPERLY REGISTERED AND R
LICENSED AS REQUIREBY ANGELES COUNTY AND STATE OF
CALJPOItliIA Oft THAT IAM' LEGAL OWNER OP,AND fKTEHD TO Rl-
Sm6 fN,THE AEOVE D ED RKS:w PROM RTY.
EIG NATO RE
OF PLRY
REPA MUKINT OF aOUN= ENCaNEEs SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUn.DING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS eNt4l;:Y Y3 BUILDING
WILLIAM J. FOX, COUNTY EIIOIN[[R ADDRESS
FOR PPU T IN
LOCALITY
BUILDING NEAREST
ADDRESS CRO Ss ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
J�
NEAREST ��O /"
CROSS ST' B ED BY Rady f•r I.pwtlo■ DATE ISSUED
OWNER Al)
MAIL USE ZONE OCCUPANCY —**Pl—
ADDRESS K PQ
CITY N0. /c
CONTRAOTOR ACA.IMP.N0.
ADDRESS JOB NO.
CITY LMO TRUNK PERMIT NO.
STATE
REGISTRATION 40. COUNTY ROAD PERMIT NO.
LEGALSTATE ENOBOACHMENT
DESCRIPTION LOT N0. • PERMIT NO.
BLOCK TRACT �6 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDBS.
NOW ON LOT
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIFTION OF WORK F[[
OUSE SEWER CONNECTING TO REIYBUBi[MENT FEE
PUBLIC SEWER • SJfS RECEIPT NO. ATE BY
HOUSE litWER CONNECTING PRIVATE DISPOSAL SYSTEM TO IJNI
6ONNrLOY AbbITIONAL BLDIL OR /ICEPTION ECOGDED
w
WORK TO HOUSE SF [R I.M
N D T[ BY
SEWER OR DISPOSAL SYSTEM 1.00 a
DISCONNEOT AND ABANDON{JEWUN
AND/OR DI{POSAL SYSTEM I.w CONNECTIO DATA
SEPTIO TANK.SEEPAot
PITS AMD OR DBAINFIELD LOO STATION DEPTH
Sr[OJAL CONDITIONS ONLY LSO MANHOLE RHFfi NC[
UPP R LOWER
TYPE F OONNECTION L GTH FROM
OWNERS PERMIT � 1 00 Y. CURB P.L. M. 0 P.L
AUTHOR[ ATION TOTAL FEE d
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAM[D
CONTRACTOR TO OONNEOT THE ABOVE DESCIUBED EXIJJTINQ APPROVALS INSPECTO"SIGNATURE DATE
DWELLING TO THE PUBLIO SEWER
SIGNED THIS DAY OF 19_
NEWHOUi[S[WHR ^�"rrr„' •-r•
OWNER OR 00NEOTADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIO TANK,SEEP.PITH)
AND/OR DRA NFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL E] DRYWELL E]CATION AND STATE THAT TH[ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAW{ ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERQ. SEWAGE DISPOSALSYSTEM
1 HEREBY' CERTIFY THAT I AM PROP[RLY REGISTERED
AMD/OR LICENSED AS EQUIRED BY ANGELES COUNTY DISCONNECT PLUQ AND
AND STATE OF CAL IA OR THA M THE LEGAL OWN• ABANDON HOUSE 6EWER
ER OF THE ABOV RIB[D R [NTIAL P[HIY. AN []
{fi[P.PIT(p CESSPOOL`
SlGNATUR[
OF� RMITTI
Mir
TGAbIfA 6f21 T/63 • .. .
4t
COUNTY OF LOS ANGELES TF34PLE CITY p 0500
9E1NIIZ PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BE 050B 1101040002
BUILDING AND SAFETY / LAND DE'VELOPKWT TFN LE CITY CA 91780
PRONE: (626) 285-0488 ETT:
LEGAL ID: SSSiER SEPTIC: SEWER BUILDING ADDRS.9S:
TR: 6561 LT: 308 EXIST OCC GRP: 9422 GARIBArDI AV
BLDOS. NOW ON LAT: TS>T) CA 917801646
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NE3ULESP CROSS STREET:
5385-006-003 ORIGINATION: THO[4AS PAGE: 596 GRID: J7 LOCALITY; TEMPLE CITY, C
LENGTH HL TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOVER: ISSOED ON: PROCESSED BY:
01/04/11 SR
COUNTY IhEPROVENEW NUh83ER:
Off: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL.BY: CODS:
LYNS, BARBARA (626) 205-5088- JOB� ��NUJMBRM / i A !G R a ���aA DJ /
9422 GAR �TnI AV PST NUD83ER: f� IG M
TEMP 917801646 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
A TADAVIT: NO SR'*M SPOT REPAIR
WAIVER: NO
APPLICANT: III,. NO. E RKWT: NO
RESCUE ROOTER (626) 858-9284-
475 E. ARROW HWY. RECORD INSTRUI-= NBR: RECORD DATE: SPECIAL CONDITIONS:
AZUSA, CA 91702 HIGHWAY/STREET WIDE2TING:
STATE ENCROACHMENT PERMIT NDHBER:
CONTRACTOR: TEL. NO: FEES PAID APPROVALS, DATE INSPECTOR SIGNATURE
RESCUE ROOTER (626) 858-9284-
475 E ARR0N HWY LIC. NO FEE DESCRIPTION: QUANTITY: DOM: AMOUNT: NEW HOU93 SEWER
AZUSA CA 91702 765155 C36
01 PERMIT ISSUANCE FEB 27.80 CONNECT ADDITIONAL
15 ALT/RSP HOUSE SEVER 1.00 EAC 30.40 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. NO: TOTAL FIMS 56.20
SEPTIC TANK, SEEPAGE PTT
LIC. NO: AND/OR DRAIN FIEID
DRYW=
SEWER I9aP BOOB: PADS: , ALTER, REPAIR, SEVER OR
DISCONNECT PIAL AND
ABANDON HOUSE SEWER
BACKFrT.i• SEPTIC TANTS _
SEEP. PTT CESSPOOL
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO BS0508