HomeMy Public PortalAbout5028 / 5024 GOLDEN WEST AVE_Sewer__ DEPAI{TMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING , V
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING ( NEAREST
ADDRESS OZ 1/Gv, /, ?. � ,- Tr CROSS ST.
LOCALITY G DISTRICT NO. SERIAL NO. (P�ERRMMITT NO.
NEAREST A �/ J J2
CROSS ST. / C)z `ED BY Ready for Inspection DATE 1 SUED
OWNER
t
MAIL7 USE ZONE OCCUPANCY MAP
ADDRESBL to I BK PG
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CITY TELAO. .
CONTRALTO y ! CO.–IMP.�NO.
ADDRESS j JOB NO.
CITY TEL.NO, l7vTRUNK PERMIT NO.
REGISTRATION NO. Q STATE Q
!j ❑ COUNTY ROAD PERMIT N0.
LEGAL1
DESCRIPTION LOT N0. �� STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTNO.OF BLDGS. f
t'f �Ll NOW ON LOT / CHARGES
USE OF
BUILDINGS CONNECTION COSQE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR CEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE BY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 41 CONNECTION DATA _
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 �t
CESSPOOL—DRYWELL STATION i .� DEPTH
SPECIAL CONDITIONS ONLY 2.00 y MANHOLE REFERENCE
UPPER COWER
TYPE OF NNECTION LENGTH FROM r
OWNERS PERMIT ; I 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS_____.------DAY OF...._ �I NEW HOUSE SEWER
OWNER OR �/ � CONNECT ADDITIONAL
OWNERS AGENT-. .. . ._ !.. tf Y,4'
BUILDING OR WORK
��jUc n . SEPTIC TANK,SEEP.PIT(S)
'___._ : AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[–] DRYWELL E]CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
NOM
PLY
COPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATEOF CALIF IA ORT T AM LEGAL OWN-
ER OF THE ABOVE
BOV ES BED S P PERTY BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)[] CESSPOOLS E]
OF PERMITTE __.____: _._
76A642A 663 7/53
i
COUNTY OF LOS ANGELES mE2= CITY 9 0508 SRIQR PERMIT
DEPART!-= OF PUBLIC WORTS 9701 LAS TUNAS 9E 0508 0803140001
BUILDING AND SAFETY / LAND DEVELOPF= TEi4PLE CITY CA 91780
PHONE: (626) 285-0488 ETT:
LEGAL ID: SEWER / SEPTIC: SEI(ER BUILDING ADDRESS:
TR: 9481 LT: 1 ON: .002 E IST OCC GRP: 5024 GOLDEN WEST AV
BLDGS. NOW ON LOT: TEMP CA 917803934
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: LA ROSA
8589-022-002 ORIGINATION: THOMAS PAGE: 597 GRID: A4 LOCALITY: TEM= CITY, C
LEND TH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/ROSIER: ISSUED ON: PROCESSED BY: EIPIRE9 ON:
03/14/08 SR 09/10/08
COUNTY II4PROVENENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DAZE F Y: CODE:
K= MADISON - JOB NUMBER:
5024 GOLDEN NFST AVE TRUNK PERMRT NUMBER:
377"-
TEMPLE CTTS CA 91780 ROAD PERMIT NUMBER: ON OF WORT
AFFADAVIT: NO NE2D TO DIG ON CITY SIDE AND REPAIR 4 Z 6 COMM=ON FOR
SOkIVER: NO SEWER
APPLICANT: TEL. NO: EASEZ455T: NO
RICHARD DpCENGURZ (626) 926-2500-
RECORD IF9TRUt412TT NBR: RECORD BATE: SPECIAL CONDTTIONB:
HIGHMAY/Si'REET WIDENING:
STATE ENCR� PERMIT NUMBER:
CONTRACTOR: TEL. NO: F'EE,4 PAID APPROVALS DATE INSPECTOR SIGHATTJRE
MALCOM'S PLUMBING 4 (626) 926-2500-
MR. ROOTER SERVICE INC. LIC. NO FEE DESCRIPTION: QUANTITY: UCM: At4OQNT: NErW HOUSE 931CIR
13167 GARVEY AVE - 767047 C36
BALDWIN PARK, CA 91706 01 PERMIT ISSUANCE FEE 27.75 CONNECT ADEDTTIONAL
15 ALT/REP HOUSE SEWER 1.00 EAC 30.45 BUILDIM OR WORE
ARCHITECT OR ENGINEER: TEL. NO: TOTAL FEES 58.20 `
SEPTIC TANK, SEEPAGE PTT
LIC. NO: AND/OR DRAIN FIELD
DR
SEWER MAP BOOK: PACE: ALTER, REPAIR, SEWER OR
SEKAGE DISPOSAL SYSTE24
DISCONNECT PLOD AND
ABANDON HOUSE SEWER
EACXYTr SEPTIC TANTS _
SEEP. PTT CESSPOOL
ORtAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO B80508