HomeMy Public PortalAbout4826 GLICKMAN AVE_Sewer__ 80811-57 APPLICATION FOR PERMIT 1
,Q19808808 11
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
JOHN A. LAMBIE, Count Engineer ADDRESS +
CASSATT D. GRIFFIN, Supt of Building LOCALITY
FOR APPLICANT TO FILL IN CROSS ST. e 4
LEGAL /
DESCRIPTION LOT NO. \ OWNER0 MAIL
/�l //
BLOCK TRACT /j9 fq
I ADDRESS S / 7 /!/, 1-1';?�fQ j/`/•S
NO.OF BLDGS. _"/�
SIZE OF LOT NOW ON LOT CITY / //v�TEL.NO.
USE OF
BUILDINGS DISTRICTI GR01P.,, MAP
CONTRACTOR I, BK- /
ADDRESS , CONNECTION DATA
CITY TEL.N0. J STATION / DEPTH
TE MANHOLE REFERENCE UPPER
REGISTRATION NO. J Sr COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $3.50
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM ITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 ®� TRUNK PERMIT NO. 'ROAD PERMIT N
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE EN AC E 7�
PERMIT 0
INDUSTRIAL
WASTE APPR A
CHARGES
OWNERS PERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ' REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. '
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF I NEW HOUSE SEWER
OWNER OR � ' CONNECT ADDITIONAL
OWNERS AGEN' a''C't-'c[-S--t BUILDINGORWORK �-�-
SEPTIC TANK,SEEP,PIT(S) c _
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE VREAD THIPPLICATION -
AND STATE THAT THE ABOVE IS CORRECT AND AGR E TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
- -
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGA OWNE F TAE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL P RTYBACKFILL SEPTIC TANKS 11SIGNATURE _f/�f �a
SEEP.PIT(S) [3 CESSPOOLS [:1OF PERMITTE c�
®° AIMATION ROBERT A. WOOD
CK. M.O, CASH SUPERVISING MECHANICAL ENGINEER
LA'
U0 4 0 7 7�; t f,"-R 25 1 o A 4.0 0
COUNTY-OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1301220016
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: ISEWER / SEPTIC: SEWER BUILDING ADDRESS:
ITR: 10992 LT: 4 BL: B (EXIST OCC GRP: 4826 GLICKMAN AV
I IBLDGS. NOW ON LOT: TEMP CA 917804018
(ASSESSOR INFORMATION NUMBER: ICONNECTION TYPE: NEAREST CROSS STREET:
18585-015-023 (ORIGINATION: _ THOMAS PAGE: 597 GRID: B5 LOCALITY: TEMPLE CITY CAI
I ILENGTH ML TO PL: STATION: DEPTH:
1TENANT: 1MANHOLE REFERENCE: UPPER/LOWER: (ISSUED ON: PROCESSED BY:
1 1 101/22/13 SR 1
ICOUNTY IMPROVEMENT NUMBER:
1OWNER: TEL. NO: IPLAN CHECK NUMBER: IFINAL DATE FINAL BY: CODE: I
ILERCH, DEBBIE (626) 444-6993- IJOB NUMBER:
14826 GLICKMAN AVE ITRUNK PERMIT NUMBER:
ITEMPLE CITY CA 91780 IROAD PERMIT NUMBER: ILJESCRON 'OF WORK 4 . I
I IAFFADAVIT: NO ISEWER SPOT REPAIR 1
1 WAIVER: NO 1
(APPLICANT: TEL. NO: (EASEMENT: NO 1
ITODHUNTER, STACY (626) 858-9284- I I
1475 E ARROW HWY IRECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS:
IAZUSA CA 91702 1HIGHWAY/STREET WIDENING:
I ISTATE ENCROACHMENT PERMIT NUMBER:
I
I I I I
ICONTRACTOR: TEL. NO: I FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE 1
IRESCUE ROOTER (626) 858-9284- 1 1 I
1475 E ARROW HWY LIC. NO IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:INEW HOUSE SEWER I I
IAZUSA CA 91702 765155 C36 I 1 1 � 1
1 101 PERMIT ISSUANCE FEE 27.80 1CONNECT ADDITIONAL it T1
1 115 ALT/REP HOUSE SEWER 1.00-EAC 30.50 1BUILDING OR WORK I 1
(ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.30 1 I I 1
1 - I 1SEPTIC TANK, SEEPAGE PITI I 1
LIC. NO: i (AND/OR DRAIN FIELD I
I DRYWELL
I I I
SEWER MAP BOOK: PAGE: I 1ALTER, REPAIR, SEWER OR I
I I 1SEWAGE DISPOSAL SYSTEM
I I I
1 I 1DISCONNECT PLUG AND I 1 I
I 1ABANDON HOUSE SEWER
I I I
1 I IBACKFILL SEPTIC TANKS I 1
I
SEEP.,PIT _ CESSPOOL
1 I 1GRAYWATER SYSTEM I 1 I
I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I I I I I I
I 1REPORT ID: DPR266 ROUTE TO : BS0508
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