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HomeMy Public PortalAbout4928 HALLOWELL AVE_Sewer__ 78A842D APPLICATION FOR PERMIT' - 8'&E-669 11-E5 - 7- DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL 1 Depar ent of County Engfrieer ' County,of Los Angeles, BUILDING -JOH,N A. LAMBIE, COUNTY ENGINEER ADDRESS ® . -CASSATT-D GRIFFIN, SUP•r Os:BUILDING LOCALITY t FOR APPLICANT TO FILL IN CROSS ST. . LEGAL OWNER - DESCRIPTION LOT NO. + MAIL - BLOCK TRACT -� � ADDRESS NO. OF BLDGSCITY 'TEL. N0: SIZE OF-LOT NOW T USE ELDF ISTRIC i GROUP MAP BUI •I - _ I BK PG CONTRACTOR - L� ADORES CONNECTION-DATA , STATION - DEPTH ' CITY TEL. N0. MANHOLE REF RENCE UPPER STATE LOWER REGISTRAT N N0. - /j� ❑ COUNTY NO. DESCRIPTION 0 W RK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. .CURB. P.L. M.L. TO P.L PUBLIC SEWER @ 0.50 SEPTIC TANK,SEEPAGE PIT OR ` PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD P. .•NO. EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $ 2.00 CO. IMP. NO. B N0. HOUSE SEWER CONNECTING,TO PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. D PERMIT N0, CONNECT ADDITIONAL BLDG.OR STATE ENCROACH T WORK TO HOUSE SEWER @ $1 00 PERMIT NO. _ ALTER,REPAIR OR ABANDON HOUSE INDUSTRI SEWER OR DISPOSAL.SYSTEM _@ $1.00 WASTE AP"ROVAL. CHARGES _ CONNECTION CHARGE FEE OWNERS PERMIT 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE EREIN NAMED CON. APPROVALS• DATE INS PECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _ TO THE PUBLIC SEWER. NEW HOUSE SEWER`- SIGNED THIS DAY OF 19 CONNECT ADDITIONAL ! OWNER- OR - BUILDING OR•WORK "! S OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)' - ADDRESS - AND/OR DRAINFIELD - I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. - - SEWAGE DISPOSAL SYSTEM' I HEREBY CE Y THAT• I AM PROPERLY REGISTER D AND/OR D CONNECT PLUG AND. LICENSED AS REO IRED BY S A GELE COUNTY A ST E OF NDON HOUSE SEWER CALIFORNIA OR, I A E LEG OWNE TH OV E ID - FEE KFILL SEPTIC TANKS❑ G AT.$ . P. PITS) ❑ CESSPOOLS❑ P R ITTEE ' JOHN-A. LAMBIE. COUNTY E4G+KEE4i VALIDATION ROBERT A. WOOD, CHIEF PLBG, INSPECTOR CK. N.0. CASH ' � 1'C,04422,' NOV 19- 4 2.0 0 . L S& -689 11-SS C APPLICATION FOR PERMIT 1 S @ E•8 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL . Department of County Engineer County of Los Angeles BUILDINSG 1. O JOHN A. LAMBIE, Cou NTY EADDRES NGINEER � ® - CASSATT D GRIFFIN, SUPT OP BUILDING -� LOCALITY 1 FOR APPLICANT TO FILL IN CROSS SI. " LEGAL DESCRIPTION LOT NO - C„= OWNER `O •.� BLOCK TRACT ,J G 'I ADDRESS SIZE OF LOT NOW ON LOT CITY• TEL. N0. '7 V USE OF DISTRICT N0. GROUP MAP BUILDINGS BK PG CONTRACTOR 1CONNECTION DATA - ADDRESS It 4141 / ' L CITY TEL. N0.4�n�%0 STATION DEPTHMANHOLE REFERENCE STATE ER REGISTRATION NO. _ Cl COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TOTYPE OF 10 LENGTH FROMyme PUBLIC SEWER @ $ 3.50 O CURB M.L. TO P.L. SEPTIC TANK,SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE.PIT, DRAINFIELDP. C. N0. EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $ 2 00 CO. IMP. NO _JOB N0. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM © $1.00 TRUNK PERMIT N0. ROAD PERMIT N0. (rJ CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1 00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT 5 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED con- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING r•' / '� TO THE PUBLIC SEWER. NEW HOUSE SEWER J �. SIGNED THIS— IC DAY OF 19 _ CONNECT ADDITIONAL OWNER OR Sa.�,�� BUILDING OR WORK OWNERS AGENT , , SEPTIC TANK,SEEP,PIT(S) ADDRESS - AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR + PLUMBING AND SEWERS. : SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY-THAT 1 AM PROPERLY REGISTERED,AND/OR DISCONNECT PLUG AND LICENSED AS REOUIRE•D'BY LOS ANGELES COUNTY AND STATE OF ABANDON,HOUSE SEWER CALIFORNIA OR THAT I AM +THE LEGAL OWNER OF THE ABOVE DESCRIBED RESID AL PROPERTY. BACKFILL SEPTIC TANKS❑ / SIGNATURE SEEP.-PIT(S) ❑ CESSPOO / !/LS Z/y 7 OF PERMITTE 1F'rx JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOO/D_, CHIEF PLEIG. INSPECTOR \ t CK. M.0. CAS % •• 4 3,4: 85 ND'41$ 4 4.550 . -1 -E���F Cir -62 76A64262 APPLICATION FOR PERMIT 1, 1 6A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FADDRESS Q �r (_! :SA t JOHN A. LAMBIE, County Engineer ( IWILLIAM A. JENSEN, Sup't of Building L€ C (L/ lJ E1` Z VFOR APPLICANT TO FILL IN . L_ LEGAL DESCRIPTION LOT NO OWNER '� LO MAIL BLOCK TRACT / 3 (y y� S Ihl- t ADDRESS NO OF BLDGS. - -SIZE OF LOT709 NOW ON LOT CITY TEL. NO. DISTRICT NO. GROUP MAP PROCESSED BY 1 BUILDINGS (,� _ Vim' /Q/J C C ��(j SK PG //ry' I/ CONTRACTOR J •U V T L ¢'¢ v 0 LI)N 1c,^• ADDRESS 2 Y X - CONNECTION DATA CITY TEL NO �a STATION t �L DEPTH r STATE MANHOLE REFERENCE7 eKn`V � B REGISTRATION NO COUNTY lk LOWE NO. DESCRIPTION OF WORK FEE TYPE OF TION LENGTH FROM -2 q� �` HOUSE SEWER CONNECTING TO Y CURB P.L M L TO P.L. LV �/� PUBLIC SEWER @ $5 00 _ SEPTIC TANK,SEEPAGE PIT OR P.0 NO. V PITS AND/OR DRAINFIELD 09 S1000 CO IMP.NO. 3 Z JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO. O PRIVATE DISPOSAL SYSTEM @ $300 ` CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER I CASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 ^" OVERFLOW SEEPAGE PIT,DRAINFIELD y EXTN,CESSPOOL,DRYWELL.MANHOLE @ $5 00 iY ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 2 Oo CHARGES AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR'S SIGNATURE I SIGNED THIS AY OF 19 OWNER ORr NEW HOUSE SEWER w OWNERS AGENT nn CONNECT ADDITIONAL - A AQ ADDRESS O� 0 C, BUILDING OR WORK y SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE'THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD C , AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING [:1PLUMBING AND SEWERS CESSPOOL ElDRYWELL I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB E D SL RIBED NABANDON HOUSE SEWER RE DE ' SIGNATURE T PRO TY,r ❑ OF PERMITTEE BACKFILL SEPTIC TANKS SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK M O y CASH ,{/ (� (^'^� {/'+�( L#`�'U G.F. L 3 4 - I1 iI 2 1 0 U 54C, 0../- � COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1103070001 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: LEGAL ID: ISEWER / SEPTIC: SEWER BUILDING ADDRESS: 1 1TR: 13645 LT: 3 1EXIST OCC GRP: I 4928 HALLOWELL AV 1 I IBLDGS. NOW ON-LOT: - �. _ ( TEMP CA 917803458 ASSESSOR INFORMATION NUMBER: ICONNECT ION:•TYPE: ' �� ` �;C' NEAREST CROSS STREET: 18585-017-003 10RIGINATION-� r' i THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY, Cl I ILENGTH ML TO PL: STATION: DEPTH: TENANT: IMANHOLE REFERENCE: UPPER/LOWER. JISSUED ON- PROCESSED BY: 1 1 103/07/11 SR 1OOUNTY IMPROVEMENT NUMBER: (OWNER: TEL. NO. IPLAN CHECK NUMBER: I DATE FI AL BY: CODE: 1 IROBBINS ROBERT (626) 575-4962- IJOB NUMBER: 14928 HALLOWELL AV ITRUNK PERMIT NUMBER: - ITEMP 917803458 IROAD PERMIT NUMBER: IDESCRIPTION OF WORK r1 1 1AFFADAVIT: NO 14 IN SEWER REPLACEMENT (WAIVER: NO i ' 1APPLICANT: TEL. NO: (EASEMENT: NO IMALOUMIAN, VICKEN (626) 826-4000- 1 1 , 17949 AJAY DR. IRECORD INSTRUMENT NBR: RECORD DATE ISPECIAL CONDITIONS: 1 ISUN VALLEY, CA 91352 1HIGHWAY/STREET WIDENING: 1 I 'ISTATE ENCROACHMENT PERMIT NUMBER: ICONTRACTOR: TEL. NO: I FEES PAID 1APPROVALS DATE INSPECTOR SIGNATURE I (EXPRESS PLUMBING ROOTER (818) 767-9800- I 1 A1 17949 AJAY DR. LIC. NO IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: INEW HOUSE SEWER ISUN VALLEY, CA 91352 796478 I 101 PERMIT ISSUANCE FEE 27.80 ICONNECT ADDITIONAL I 1 1 115 ALT/REP HOUSE SEWER 1.00 EAC 30.40 IBUIL61NG OR WORK 1 1 1 1ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.20 1 1 1 1 - I ISEPTIC TANK, SEEPAGE PITI 1 LIC. NO: I 1AND/OR DRAIN FIELD I 1 1 1 1DRYWELL I 1 1 I I I 1 SEWER MAP BOOK: PAGE- 1 1ALTER, REPAIR, SEWER OR I I I (SEWAGE DISPOSAL SYSTEM I I I IDISCONNECT PLUG AND 1 I 1 I I (ABANDON HOUSE SEWER I I I 1 1 1BACKFILL SEPTIC TANKS 1 1 1 (SEEP. PIT _ CESSPOOL 1 1 1GRAYWATER SYSTEM 1 1 1 I I I I I 1 I 1 1 I I I I I I I I I I I I I I I I I I 1 1 I I I I I I I I I I 1 IREPORT ID: DPR266 ROUTE TO BS0508 1 1 I 1 I I I I I I