HomeMy Public PortalAbout6439 GOLDEN WEST AVE_Sewer__ 7•A64
2
DAPPLICATION - FOR PERMIT
K-
* sDIVISION OF BUMDMC; AND SAFETY SEWER—SEWAGE DISPOSAL. T
D.p=h.=.t of Cour E.Waw
Com of LasAnov]t DUILDING
ADDRESS
WM.J.FOk, COLiItTY 6Nanvme
CA ZATT D.aIUrRIN, tur'T of tuQ..DDIIe LOCALITY
FOR APPLICANT TO FILL IN NEAREST
LEGAL '
DESCRIPTION LOT 110. --mm
BLOCK TRACT PAIL
ADDRE8D
SIZE OF LOT .. C/ NOW OR BL
T CITY
/ TET,. 110.
BSE�F
L Q a DISTRICT110. GROUP YAP
BK PG
CONTRACTOR
ADQREBS CONNECTION DATA
� lfTN0. L ff, DEPTH z A , .
g STATE YAXHOU REFERENCE f
REGISTRATION NO. /�] COUNTY LOWS
NO,TDESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TSE ECTION LENGTH FROM ? C
Y. URB P L Y.L. TOP J
PUBLIC SEWER 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO, IMP. XO J05 X O
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING V4�r�,/q .��
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. V
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO
I SEPTIC TANK,SEEPAG9 PIT OR
PITS AND/OR DRAINFIEL.D .00 INDUSTRIAL
CESSPOOL-DRYWEII W&ErE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OQppEg'$ Pf�T S 1 00
JJAUMORIZATION ITO'PAL FEE REIMBURSEMENT FEE
T'RACTORTHIS
CONNECT TTHEABOVE DESCRIBED RXIITH THE ESTINGIN ADWELLIMED OXG APPROVALS DATE INSPECTOR-2 SIGNATURE
TO THE PUBLIC SEW �•
�y NEW HOUSE SEVER
SIGNED THI AY OF !9 v
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(81
ADD &ZZA. AHD/OR DRAIXFIELD
1 HEREBY ACLHQWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWEL.L❑
AND STATE THAT THE ABOVE 13 COBRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER, REPAIR,SEWER OR
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AAD/OR ALTER, DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LAD ANGELES COUN AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AY THE LEG OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENT PROPENTY. BACKFILL BEC TAMILS❑
SEYP. PIT D T CESSPOOLS !
"'NATUIZE
OF PERYI /
WILLIAM J.FOX, ENGLNJ3[R FL A.WOOD, CCNIQr Pua,[Nor[croN
I
&5948 mAy14 4 ,5 [' In
OOUN!'Y OF LOS ANGEa FS TEMPLE CITY 0508 SEWER PE041T
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1005190001
BD-ILDIPO AND SAFS!'Y / LAND DEVE,00IM L' TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER SEPTIC: SEWER BUILaIIiO ADDRESS:
ON FILE ED= OCC GRP: 6439 GOLDEN W&ST AV
BLDGS. NOW ON LAT: TE34P CA 917801423
A93E<980R INFORMATION NUISYR: CONNECTION TYPE: NEAREST CROSS STREET:
5383-016-004 ORIGI2=ON: TB069LS PAGE: 597 GRID: Al LACALITY: TEMPLE CI'T'Y, C
LENGTH ML TO PL: S'LATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LASER: ISSUED ON: PROCFL9SED BY:
05/19/10 SR
COUNTY II[PROV'EMBNT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: F DATT{ BY: CODE:
DONNERS00ED, DANIEL - JOB N13 BER:
6439 GOLDEN W= AV TY= PER?IT NUMBER:
TERP 917801423 ROAD PERMIT NUMBER: OF OF WORK
AFFADAVIT: NO REPLACE EXISTING SEWER LINE
MASVER: NO
APPLICANT: TEL. NO: RASEENr: NO
ROBERTS PAUL (626) 798-10725-
3228 ALAN = AVE RECORD INSTRUI-= NBR: RECORD DATE: SPE CONDITIONS:
ROSEMBAD, CA 91770 HIGTIMAY/8TREET WTDEfIM:
BTATE ENCBOA(HN]iNTP PERMIT NUMBER:
CONTRACTOR: TEL. NO: FE S PAID APPROVALS DATE INSPECTOR SIGNATURE
PAUL ROBERTS CO. (626) 798-0725- -
FBRCADO MANUEL LSC. NO IFEE DESCRIPTION: QIDNITTY: UOMS: AMOUNT: NEW HOUSE SEWER
3228 ALENDRTi'M AVENUE 839456 C42
ROSEMEAD, CA 91770 01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
13 WORK TO HOUSE SEWER 1.00 EAC 30.45 BUILDING OR WORT
ARCHITECT OR ENGINEER: TEL. NO: TOTAL FEES 58.20
SEPTIC TANK, SEEPAGE PIT
LIC. 190: AND/& DRAIN FIELD
DRYWELL
8E1BI2 MAP BOOK: PAGE: ' ALTER, REPAB, SEEKER OR
SEWAGE DISPOSAL SYSTEM
DISCORN= PLUG AND
ABANDON HOUSE SEWER
BACXF= SEPTIC TANKS _
SEEP. PIT CESSPOOL
GRAYWATrKR SYSTEM
1
REPORT ID: DPR.266 ROUTE TO 1390508
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