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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0303130005
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: 4840 GOLDEN WEST AV
BLDGS. NOW ON LOT: TEMP CA 917803935
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: LOWER AZUSA
8589-020-024 ORIGINATION: THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
COUNTY IMPROVEMENT NUMBER: 03/13/03 JK 09/09/03
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
JOSE AND MARIA ESPINOZA (626) 287-5421- JOB NUMBER:
4840 GOLDEN WEST AV TRUNK PERMIT NUMBER: `z-[^c�
TEMP 91780 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO CONNECT EXISTING HOUSE TO PUBLIC SEWER
WAIVER: NO
APPLICANT: TEL. N0: 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 �
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