HomeMy Public PortalAbout4836 GOLDEN WEST AVE_Sewer__ •
76AS420
CE808.e.58. APPLICATION FOR PERMIT 1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Sup't of Building LOCALITY r P�
FOR APPLICANT TO FILL IN NEAREST r/ _ �� �a„
CROSS ST. ;�L��
LEGAL �J
DESCRIPTION LOT N0. OWNER 'Azle
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY 0. N F
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
/
CONTRACTOR /� � p / HK PG
J�
ADDRESS 170 J CONNECTION DATA
CITY ��t C,tom TEL.NO. 4(—?3 STATION DEPTH
STATE
REGISTRATION NO. ® COUNTY MANHOLE REFERENCE UPPER.
NO. DESCRIPTION OF WORK FEE LOWER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OFC NECTION LENGT ROM
PITSIC TANK,SEEPAGE PIT OR @ $3.00 �1 T. CU P.L. M. 0 P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.N0. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROAC ENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRI
WASTE&FPROVAL
CHAR ES
OWNERS 'PERMIT $ p2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE (sem REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON_ APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
NEW HOUSE SEWER
SIGNED THIS------DAY OF 19— -
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I 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
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS[I/..
/may /�' �+y�` SEEP.PITS) ❑ CESSPOOLS El
( � s � m
OF PERMITTEE ✓— ZZL"' '
Or ALMATION/'1. ROBERT A.WOOD
Y.0. f c�Asx>,� SUPERVISING MECHANICAL ENGINEER
�- - COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0303130003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER / SEPTIC: X BUILDING ADDRESS:
ON FILE EXIST OCC GRP: 4836 GOLDEN WEST AV
BLDGS. NOW ON LOT: TEMP CA 917803935
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: LOWER AZUSA
8589-020-026 ORIGINATION: THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BM EXPIRES ON:
COUNTY IMPROVEMENT NUMBER: 03/13/03 JK 09/09/03
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
SALAMA JOHN AND SAMMY (626) 286-9445- JOB NUMBER: v
4836 GOLDEN WEST AV TRUNK PERMIT NUMBER: 'Z O 3 I
TEMP 917803935 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO CONNECT EXISTING HOUSE TO PUBLIC SEWER
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
MLADEN GRBAVAC CONT CO (626) 355-1350-
P.O.BOX 660219 RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
ARCADIA 91006 HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
MLADEN GRBAVAC (626) 355-1350-
1235 RAMONA ROAD LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER
P.O. BOX 150 NONE '3-
ARCADIA, CA 91006 01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
03 CONN TO PUBLIC SEWER 1.00 CON 46.95 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. NO: TOTAL FEES 74.70
SEPTIC TANK, SEEPAGE PIT
LIC. NO: AND/OR DRAIN FIELD
DRYWELL
SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS _
SEEP. PIT CESSPOOL
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO BS0508