The URL can be used to link to this page

Home My Public Portal About6208 GOLDEN WEST AVE_Sewer__ 76A842D,, CE 808(REV 6,78) 1/79 AP P L CAT N FOR P T ®s• SEWER - EWAGE DISZSAL COUNTY OF LOS ANGELES BUILDING AND SAFETY FOR APPLICANT TO FILL IN DISTRICT NO GROUP MAP CESSED BY BK PGBUILDING � ADDRESS �� 4� � �✓ LOCALITY �fr y L G�+ CONNECTION DATA NEAREST STATION DEPTH CROSS ST . UPPER MANHOLE REFERENCE V /tom/AITIJ•/a�C LOWER OWNER TYPE OF CONNECTION LENGTH FROM MAIL Y CURB PL M L TO P L ADDRESS a �(/�/ T ``,, �� /� �J P C NO CITY / 44;; TEL NO c;: �L,177c CO IMP NO JOB NO LEGALTRUNK PERMIT NO ROAD PERMIT NO DESCRIPTION LOT NO AFFIDAVIT I WAIVER I EASEMENT RECORD INSTR NO DATE BLOCK TRACT NO OF SLOGS SIZE OF LOT NOW ON LOT HWY OR ST WIDENING USE OF BUILDINGS STATE ENCROACHMENT PERMIT NO CONTRACTOR INDUSTRIAL WASTE APPROVAL ADDRESS CHARGES CITY TEL NO CONNECTION CHARGE FEE STATE LIC REIMBURSEMENT FEE 1111. LICENSE NO CLASS O NO DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR S SIGNATURE V HOUSE SEWER CONNECTING TO I O PUBLIC SEWER SEPTIC TANK,SEEPAGE PIT OR NEW HOUSE SEWER F- PITS AND/OR DRAINFIELD CONNECT ADDITIONAL HOUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM CONNECT ADDITIONAL BLDG OR SEPTICTANK SEEP PITS) AND/OR DRAINFIELD WORK TO HOUSE SEWER e OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL C3 DRYWELL❑ EXTN CESSPOOL,DRYWELL MANHOLE ALTER,REPAIR OR ABANDON HOUSE ALTER REPAIR,SEWER OR SEWER OR DISPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS❑ Permit s O SEEP PIT(S)❑ CESSPOOLS❑ OWNER'S VALIDATION AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER /'9 3.5 A SIGNED THIS DAY OF 19 �7 OWNER OR OWNERS AGENT # 0 0 0 O 110 ADDRESS 2,,- 014,00 , 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION / AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY f O'I O 1 G,O O U WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING O PLUMBING AND SEWERS I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR I 1.2'6'-- ./ LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO RE- SIDE IN THE ABOVE DESCRIBED RESIDENTIAL /P/PROPERTY SIGNATURE OF PERMITTE l+ 24650 INSERTS CE806.60 8 78A842D APPLICATIONAPPLICATIONI=OR 'PERMI,T r COUNTY OF LOS ANGELES SEWER=SEWAGE_DISPOSAL 1 DEPARTMENT OF COUNTY,ENGINEER ' BUILDING BUILDING AND SAFETY"OrnSION ;ADDRESS - JOHN A. LAMBIE, County Eag�neer WILLIAM A. JENSEN, Supt of Building "LOCALITY ' 'NEAREST :PPLKESSED FOR APPLICANT TO FILL IN CROSS•ST. LRIPT OWNERDESCRIPTION LOT N0.BLOCK 'TRACTMAILADDRESSNO OF BLI;DGS.SIZE OF LOT NOW ON LOT CITY TEL NOUSE OF DIDISTRICT N0. GROUP MAP BY BUILDINGS I BK PG " CONTRACTOR K[ ADDRESS .�• - 'CONNECTION DATA CITY TEL NO- S TION - - DEPTH �Q t ` �� ATE MANHOLE REFERENCE REGISTRATION NO V COUNTY LOWER NO DESCRIPTION Or/WORK f FEE / HOUSE SEWER CONNECTING TO PUBLIC SEWER Co) $3 00 TYPE OF CONNE TI LENGTH FROM SEPTIC TANK SEEPAGE PIT OR M.L.TO P.L. ITS AND/OR DRAINFIELD @-$3 00 •�• OVERFLOW SEEPAGE PIT, DRAINFIELD - EXTN CESSPOOL DRYWELL @ $2 00 HOUSE SEWER CONNECTING TO / L� 5}// P.JOBB NN0.. CO IMP N0. t.� O. PRIVATE DISPOSAL SYSTEM @ $1 00 CONNECT ADDITIONAL BLDG ORP.TRUNK PERMIT NO. ROAD PERMIT N0. , WORK TO HOUSE SEWER @ $1 00 U ALTER, REPAIR OR ABA DO OUSE STATE ENCROACHMENT Pq SEWER OR DISPOSAL S T @ $1 00 PERMIT NO O INDUSTRIAL U WASTE APPROVAL W CHARGES dal OvvmR'S PERMIT $ CONNECTION CHARGE FEE rl AUTHORIZATION TOTAL FEE REIMBUkRSEMENT FEE CON- TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTIDATE A CONTRACT WITH THE �NGAMED DWELLING APPROVALS .DATE INSPECTORS SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF_ 19_ NEW HOUSE SEWERS �d 60 OWNER OR CONNECT ADDITIONAL ( OWNERS AGENT BUILDING BUILDING OR WORK - - - - ADDRESS - SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THATI HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ f � WITH ALL COUNTY'ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR ` PLUMBING AND SEWERS: - SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY HAT,1 AM PR PERLY REGISTERED AND/OR DISCONNECT PLUG AND " LICENSED AS-RE 1 D B OS AN LES COUNTY AND STATE OF 'uISCON N CT PLUG-AND - ' CALIFORNIA,OR H T THE EGAL OWNER OF THE ABOVE DESCRIBED RESBACKFILL SEPTIC TANKS ❑ •,S EP PIT(S) ❑ -CESSPOOLS j:1 _ �) SIGNATURE OF PERMITT ` I'®R VALIDATfROEJERT A. WOOD I CII, H.0. _ CASH SUPERVISING MECHANICAL ENGINEER AP 1 7-2 9 '- r�'AUG `� l D _ "' a 246501NSERTS -CE8088.8D APPLICATION FOR PERM°IT 'p' 1.6,12DCOUNTY OF LOS ANGELES SEWER-SEWAGE ,DISPOSAL _ , DEPARTMENT OF COUNTY ENGINEER ' BUMDING AND SAFETY DIVISION' AD�REssG .�G1�A�,r✓ g'id �;" r, 12HN A. LAMBIE, County Enggineer WILLIAM A. IENSEN, Sup'f of Building r LOCALITY FDESCRIPTION APPLICANT TO FILL IN CROSS ST OWNER LOT N0. MAIL TRACT ADDRESSNO OF BLDGS.NOW ON LOT ` ,CITY+ TEL NO USE OF DISTRICT N0. GROUP MAP P CESSED BY BUILDINGS �B �- BK PG I ` CONTRACTOR J U I ADDRESS 3 Z ,Z E QONNECTION DATA CITY TEL.NO. '"— 'STAT N �--D��" DEPTH STATE MANHOLE REFERENCE - REGISTRATION NO � COUNTY - LOWER' NO DESCRIPTION OF VMRK FfE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3 Ob TYPE OF CO LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR U P.L. M.L.TO P L. PITS AND/OR DRAINFIELD _ @ $3 00 - - OVERFLOW SEEPAGE PIT, DRAINFIELD ' EXTN CESSPOOL DRYWELL @ $2.00 _ ." HOUSE SEWER CONNECTING TO P,C,NO, PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP N0. JOB NO. CONNECT ADDITIONAL BLDG OR WORK TO HOUSE SEWER @ SI 00 'TRUNK PERMIT N0. _ ROAD PERMIT N0. Q U - ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT Ip SEWER OR DISPOSAL SYSTEM @ $100 )PERMIT NO p 'INDUSTRIAL j WASTE APPROVAL WM CHARGES V1 OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE fO 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 0 19_ NEW'HOUSE SEWER OWNER OWNERS AGENT /~1�s CONNECT ADDITIONAL 'v BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD 1 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 PLUMBING AND SEWERS gLTER,REPAIR„SEWER OR - L 'SEWAGE DISPOSAL SYSTEM _ I HEREBY CERTIFY THAT 1 M PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND - LICENSED AS REQUIRED BY OS ANGELES COU TY AND-STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1 THE LEGAL 0 ER OF THE ABOVE DESCRIBED RESIDENTIAL OPERBACKFILL SEPTIC TANKS El ^• SIGNATURE •SEEP.PIT(S) ❑ CESSPOOLS ❑ _ - ` OF PERM ITTE aw 44 ®� VALIDATION ROBERT A, WOOD CB, N.0. CASH J SUPERVISING MECHANICAL ENGINEER - -- LIti7J 8 AUG L n 5 :0 0' ca rr COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1105190001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE (626) 285-0488 EXT- LEGAL ID ISEWER / SEPTIC SEWER BUILDING ADDRESS ON FILE IEXIST OCC GRP- 6208 GOLDEN WEST AV IBLDGS NOW ON LOT TEMP' CA 917801704 (ASSESSOR INFORMATION NUMBER ICONNECTION TYPE1 15385-025-017 (ORIGINATION NEAREST CROSS STREET THOMAS PAGE 597 GRID A2 LOCALITY TEMPLE CITY, C , ILENGTH ML TO PL STATION DEPTH (TENANT- IMANHOLE REFERENCE UPPER/LOWER- (ISSUED ON. PROCESSED BY- 1 1 105/19/11 SR I ICOUNTY IMPROVEMENT NUMBER OWNER TEL NO IPLAN CHECK NUMBER- IFINAL D TE FINAL BY. CODE ICARLSON, PATRICIA (949) 370-8247- (JOB NUMBER- I 16208 GOLDEN WEST AVE ITRUNK PERMIT NUMBER I '-y A/ ITEMPLE CITY CA 91780 (ROAD PERMIT NUMBER- IDESCRIPTION OF WORK 1AFFADAVIT NO ITO FINALIZED EXPIRED PERMIT CONVERT GARAGE TO BEDROOM, 1 IWAIVER NO IBATHROOM AND NEW GARAGE 1 (APPLICANT- TEL NO (EASEMENT NO I ISAME AS OWNER - I I IRECORD INSTRUMENT NBR RECORD DATE (SPECIAL CONDITIONS (HIGHWAY/STREET WIDENING ISTATE ENCROACHMENT PERMIT NUMBER I I _ ICONTRACTOR TEL- NO i FEES PAID 1APPROVALS DATE INSPECTOR SIGNATURE 1 (SAME AS OWNER - I LIC NO IFEE DESCRIPTION: QUANTITY UOM AMOUNT- INEW HOUSE SEWER I 1 101 PERMIT ISSUANCE FEE 27 80 (CONNECT ADDITIONAL I I I 113 WORK TO HOUSE SEWER 1 00 EAC 30.40 IBUILDING OR WORK 1 1 I (ARCHITECT OR ENGINEER• TEL NO TOTAL FEES 58 20 1 1 1 - (SEPTIC TANK, SEEPAGE PITT- I LIC NO i (AND/OR DRAIN FIELD I I I I IDRYWELL I SEWER MAP BOOK PAGE 1 (ALTER, REPAIR, SEWER OR I I I 1 (SEWAGE DISPOSAL SYSTEM I 1 (DISCONNECT PLUG AND (ABANDON HOUSE SEWER I I I 1 1 (BACKFILL SEPTIC TANKS =I 1 I 1 ISEEP PIT CESSPOOL I IGRAYWATER SYSTEM I I I I I I I II I I I I I I I I I I I I I I I I I I I I 1 I I I I I I I I (REPORT ID DPR266 ROUTE TO BS0508 I I I I I I I