HomeMy Public PortalAbout10236 GREEN ST_Sewer__ ;,°A�;11.Sy APPLICATION FOR PERMIT 1
DWIMON OF BUILDING AND SAFETY SEWER—SEWAGE DISPQSAL
D.parft .m! of Ott Emulnew
Conat7 of Los Angel" FU D I G
JOHN A.LAMBIE, CouNTY ENGINEER E� rr
m CASSATT D.ORIFFFN, Sur 7 of BUILDiNo Lm
FOR APPLICANT TO FELL IN E ST.
cc
LEGAL OWNERt'
DESCRIPTION LOT N0.
MAIL Ile'
BLOCK TRACT - ADDRESS
N0. OF SLOGS. CITY TML. N0.
SIZE F LOT ROW ON LOT
USO
BUILDINGS DISTRICT NO. GROUP MAF
B[ PG
CONTRACTOR
ADDRESS CORRECTION DATA.
_ STATION DOTH
C NO. ■ANHOLE REFERSa10E PPEA
LOWER
REGISTRATION NO f ❑ COUNTY
NO. DESCRTFTIQN OF'WORK FET `
T
HOUSE SEWER CONNECTING TO X.L.TYPE OF CONNECTION S LENG -
Y. CURB P.L. TOO P.L.
PUBLIC 6E1/ER @ 3.50 ,
SEPTIC TANK,SEEPAGE PIT OB
PITS AND/OR-DRA RFIELD ® 3.00
OVERFLOW SEEPAGE PIT,DRAINFIE P. C..NO.
I
EXTN.,CESSPOOL DRY-WELL MANHOLE 2.00 CO. INA. NO. JOB N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL STEM ® 11.00 TRUNK PERMIT N0. "' ROAD PERMIT-NO -
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
VOR[TO HOUSE SEWER B 1 1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE
INDUSTRIAL
SEINER OR DISPOSAL SYSTEM ® 1.00
WAf7fi APPROVAL
CHARGES
CONNECTION CHARGE FEE_
OWNER'S PFHMIT s 1 00 .
AUTHORIZATION TOTAL SEE REIMBURSEMENT FEE
I HAQfi AT THIS DATE A COXTRACT WITH THE HEREIN RAISED Com- APPROVALS DATE IXSPF�CTOR'SSIGNATURE
TRACTOR TO CO
XNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS' nAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING WORK _
OWNERS AGENT EPTICTANK-,,'SEEP',PIT(5)
ADDRES VV(5R"ffkAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEDER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED B 0 ANGE COUNTY AND STATE OF
CALIFORNIA OR THAT I E ER OF THE ABOVE ABANDON HOUSE SEWER
DESCIIBED RESIDER BACKFILL SEPTIC TANK$❑
SIGNATURE �, SEEP.PIT(3) ❑ CESSPOOLS❑,
OF PERMITTEE
JOHN A. LA IE, COUNTY NEER VALIDATION ROBERT A.WOOD, CHIEF PLDO. INHPECiOR
c[ ■.0. CAM
X0 4 D � 9� APR �]_ 41 J�C3 0 �
it _ _ _ _ .
TeAe4ED
CE84DO 2-61
APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDR[►f Q Z
COLEMAN W.JENKINS, SUPT. OF BUILDING
• LOCALITY
N-.REST
FOR APPLICANT TO FILL IN CROSS ST.
LROAL
DESCRIPTION LOT NO, OW H[R
MAIL
BLOCK TRAGI ADDRESS
NO. OF OLD"
SIZE OF LOT NbW ON LOT CITY TEL. NO,
USK OF
BUILDINGS DI IGT N GROUP YAP EY
BU
BK PO
CONTRACTOR ���
ADDR[SD Q CONNECTION DATA
CITY TF4-.. NO. STATION tl J ^ DEPTH
STAT[ LIC
MANHOLE REFERENCE / I FP;R
LICENSE NO17e? 7S O (n-Asa �+'� {J L R
NO. DESMIPTION OF WORK FEE TYPE OF CONNECTI LEND OM
HOUSE■ ER CONN[Cn NG TO Y. CURB T .L /d/
PU■L IC SEWER / SB.00 P.C. // O
■ [PAGE PIT OR
_ SEPTIC TANK, O.
PITS AND/OR DRAINFIELD f' 510.00 CO.IMP.NO.
HOUSE S[W[R CONNECTING TO TRUNK PERMIT NO. It(?AR
D PERMIT Nb.
PRIVATE DISPOSAL SYSTEM � 5].00 O
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT Wi6mi WOf[R RECORD.I11STR.NO. DATE
WORK TO HOUSE SEWER 55.00 -
OV FLOW SEEPAGE PIT.DRAINFI[ d
EXTN.CESSPOOL.DRYW[LL MAN H OLE r SE.00 (/7
ALT .R AIR A ON OU■ HWY.OR or,WIDENING
■EWER OR DISPOSAL SYSTLM $3.00 STATE[NCROACHMLN`T
FERMIT NO.
INDU"AL
WASTE APPROVAL
OWNER'S PERM T It 2 00 CHARD t./
CONNECTION CHARO[FES
ApTHOR'IZATION rorA>; Fm
I HAVE AT THISDATE A CONTRACT WITH THE H[R[IN NAMED C,OH- RIIMEURSEMINT FEE
TRACTOR TO CONNECT THE ABOVE DKACRII§ D ESISTIIIG )WELLING
TO TH[ PUBLIC SEW APMOVAU T[ INSPECTOR' 1 NA R[
SIGNED THIS DAY QF 1fl_ -
OWN[R OR Lj(�J/ NEW MOUES ErW[R
OWNERS AGE CONNECT ADDITIONAL
/O_ b
ADDRES BUILDING dR WORK )
1 HERBY ACKNOWL 0E THAT I HAVE R HIS APPLI N SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFI[LD
AND STAT[ THAT THE ASgVE IS CORRECT AN AGREE TO 4 LY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGU TI NO CESSPOOL Cl DRYW[LL ❑
PLUMBING AND SEWERS.
I HEREBY CERTIFY THAT I AM PROPIRLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LI IC:
AS REQUIRED ANGLES COUNTY AND STATE OF SEWAGEDISPOSAL SYSTEM
CA LI RORNIA OR THAT LIOAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND _
RESIDE IN, THE A RIS[D RESIDENTIAL PROPERTY. ABANDON HOUSE erw ER
SIGNATURE MACKFILL S[P�IC TANKS ❑
OF PvXR ■EP,PIT(S) LJ CLSSPOO
OVAMATION
. JACK , ALLEN
M.0. GASP{ SUPERVISING MFCHANICAL ENGINEER
LA(;o 7 4 9 9 QAC 3 1 0-0 7.00-
L
.00-L
COUNTY OF LOS ANGELES TEMPLE CITY 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0201280001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (676) 285-048B EXT: .
LEGAL ID: SEWER SEPTIC: Y BUILDING ADDRESS:
ON FILE EXIST OCC GRP: 10236 GREEN $T
ASSESSOR INFORMATION NUMBER: BLDG$. NOW ON LOT: TEMP CA 917803336
CONNECTION TYPE: NEAREST CROSS STREET. HAL DWI It
8585-OD6-021_ ORIGINATION: THOMAS PAGE: 597 GRID: 34. " LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
MANHOLE REFERENCE: UPPER/LOWER: .
01/2B/02 JK 07/27/02
COUNTY IMPROVEMENT NUMBER:
UWNLK: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY:
VAUGHT;COREY (626) 443-8090- JOB NUMBER:
10236 GREEN ST TRUNK PERMIT_ NUMBER:
TEMP 917803336 r. .( iT h,r'�.;' r ROAif PERMII7 AUIE3M: -- - —
i?>Tif 'i t FFADAVIT: NO CONNECT ADDITION TO HOUSE SEWER
WAIVER: NO
APPLICANT: TEL. . EASEMENT: NO
SAME AS OLMER -
RECORD INSTRUMENT NBR: _ RECORD. DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET-WIDENING:
STATE ENCROACHMENT PERMIT-NUIBER:
CONTRACTOR: TEL. W:
SAME AS OWNER
LIC. NO FEE DESCRIPTION: QUANTITY: LOM:" AMOUNT: NE61 HOUSE SEWER
01 PERMIIT ISSUANCE FEE'. 27.75
13 WORK TO,HOLJ$E SEWER - 1.00 EAC 30.45 . BUILDING OR WORK Z.yr.p7,-
ARCHITECT OR ENGINEER: -,.NOTAL FEES 58.20
SEPTIC
LIC. NO: i — - AMD/OR DRAIN FIELD
DRYWELL
sr= MAP BOOK: PAGE:
ALTER REPAIR SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCOMECT PLUG AND
- - -- ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS
SEEP. PIT _ CESSPOOL
REPORT ID: .DPR266 ROUTE TO RSD508