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HomeMy Public PortalAbout5935 HART AVE_Sewer__ sg 50 i CE808 8.80 /rel P 11 LO CAT MN FOR II E 8 11 M T . �snsazu COUNTY OF LOS ANGELES SEYVER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER r � BUILDING AND SAFETY DIVISIONADDRESS Bu1LDING ,e— ' ineer WILLIIAA .JJENSEN, Supt of MABuilding LOCALITY � d NEAREST -r FOR APPLICANT TO FILL IN CROSS ST. LEGAL OWNE / _ DESCRIPTION LOT NO. BLOCK TRACT ® MAIL - ADDRESS ' NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO.USEO • - BUILDINGS D � DISTRICT NO. GROUP" MAP PROCESSED BY ' BUILDINGS CONTRACTOR ' , ! I BK _ I ` CONNECTION DATA CITY-® t TEL.N0. 1STATION DEPTH REGISTRATION NO. L � STATE �COUNTY ,MANHOLE REFERENC - UPPER LOWER No. DESCRIPTION OF WORK FEE , HOUSE SEWER CONNECTING TO / PUBLIC SEWER @ 3.00 TYPE OF CONNECITION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ 3.00 z OVERFLOW SEEPAGE PIT. DRAINFIELD - EXTN..CESSPOOL. DRYWELL @ 2.00 HOUSE SEWER CONNECTING TOP.C.NO. PRIVATE DISPOSAL SYSTEM @ 1.00 CO.IMP. NO. JOB CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. OAD PERMIT N0. O WORK TO HOUSE SEWER @ 1.00 . *,0V.. ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMEN W SEWER OR DISPOSAL SYSTEM @ 1.00 PERMIT NO. O INDUSTRIAL WASTE AP OVAL W CHARGES OWNERS PERMIT $ p �� CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE .0c REIMBURSEMENT FEE I HAVE AT DATE A CONTRACT WITH THE HEREICON- TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTINGAMED DWELLIING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. o ' SIGNED THIS DAY OF 19_ NEW HOUSE SEWEROWNER OR /h", A ��//�J �p OWNERS AGENT i BUILDING OR WOR KNECT AL- Zd sir /J//f{�/l��V"" - ' ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION -AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ i- WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING t ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR. F DISCONNECT PLUG AND LICENSED AS REQUIRED B ANGELES D STATE.OF' ABANDON HOUSE SEWER / CALIFORNIA OR THAT 1 M E LEGA 0 OF HE ABOVE DESCRIBED RESIDENTI ROP TY. BACKFILL SEPTIC TANKS ❑ �.t /f/���' .,y)j'Gi� - SEEP. PIT(S) ❑ CESSPOOLS t❑ /I� /.,L`-'r/•"h" . SIGNATURE OF PERMITTE ®P" VALIDATIO ROBERT A. WOOD Ca. M.o. CASH SUPERVISING MECHANICAL ENGINEER 3 1:-2 5% AUG16 1 0 0 5.00,. Q / 24650 INSERTS `E°°96.8° APPLICATION FOR PERMIT 76A642D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING BUILDING AND SAFETY DIVISION ADDRESS JOHN A. LAMBIE. County Engineer WILLIAM A. JENSEN, Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT N0. OWNER d BLOCK TRACT �' MAIL ADDRESS N .OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE DISTRICT N0. Y P BK MAP PG PROCESSED BY BUILDDI,NGS I CONTRACTOR ADDRESS c CONNFrTTI` N DATA ' CITY f: L.N0. STATION i- 7 jY DEPTH ,j —Z STATE MANHOLE REFERENCE UPPER REGISTRATION N0. COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER Cv $3.00 © TYPE OF RB TION LENGTH FROM SEPTIC TANK.SEEPAGE PIT OR Y. 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.N0. PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. N0. JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. C O O WORK TO HOUSE SEWER @ $1.00 _ U ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO, 0 INDUSTRIAL U WASTE APPROVAL µ7 CHARGES W OWNERSPERMIT 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT E ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEW SIGNED THIS DAY OF 19 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY A NOWLEDGE 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. ALTER,REPAIR,SEWER OR SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF AgpNDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LE OWNER OF THE ABOVE DESCRIBED RESIDEN PROPER Y. BACKFILL SEPTIC TANKS ❑ SIGNATURE SEEP.PITS) ❑ CESSPOOLS ❑ OF PERMITTEE ®� LIDATION ROBERT A. WOOD CK. I/ H.0. CASH SUPERVISING MECHANICAL ENGINEER Lti�,o 2 8 8 4 AUG 13 1 0 D 7.00- v COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1312180008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: ILEGAL ID: ISEWER / SEPTIC: SEWER BUILDING ADDRESS: I ITR: 5904 IT: 328 IEXIST OCC GRP: 5935 HART AV I IBLDGS. NOW ON LOT: ' TEMP CA 917801913 (ASSESSOR INFORMATION NUMBER: ICONNECTION TYPE: I : NEAREST CROSS STREET: 15384-015-025 (ORIGINATION: I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY CAI I ILENGTH ML TO PL: STATION: DEPTH: (TENANT: IMANHOLE REFERENCE: UPPER/LOWER: (ISSUED ON: PROCESSED BY: 1 I 112/18/13 SR COUNTY IMPROVEMENT NUMBER: I1 (OWNER: TEL. NO: IPLAN CHECK NUMBER: IFINAL DATE FII BY: CODE: IHINSON, MATT - I.JOB NUMBER: 16230 ROWLAND AV ITRUNK PERMIT NUMBER: 1 % 1 ITEMP 917801724 IROAD PERMIT NUMBER: 1DESCRIPTION OF WORK 1 IAFFADAVIT: NO ISEWER SPOT REPAIR I IWAIVER: NO (APPLICANT: TEL. NO: (EASEMENT: NO ITODHUNTER, STACY (626) 858-9284- I 1475 E ARROW HWY IRECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS: 1 1AZUSA CA HIGHWAY/STREET WIDENING: n� I ISTATE ENCROACHMENT PERMIT NUMBER: -4" Q. s ICONTRACTOR: TEL. NO: I FEES PAID 1APPROVALS T DATE INSP CTOR SIGNATURE 1 IRESCUE ROOTER (626) 858-9284- 1-1 1475 E ARROW HWY LIC. NO '•I FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: INEW HOUSE SEWER I I I 1AZUSA CA 91702 765155 1 `101 PERMIT ISSUANCE FEE 27.80 (CONNECT ADDITIONAL ;115 ALT/REP HOUSE SEWER 1.00 EAC 30.50 BUILDING OR WORK (ARCHITECT OR ENGINEER: TEL. NO: 1I TOTAL FEES 58.30 - I ISEPTIC TANK, SEEPAGE PITI I 1 LIC. NO: I (AND%OR DRAIN FIELD IDRYWF.LL I' I I I SEWER MAP BOOK: PAGE: 1 1ALTER, REPAIR, SEWER OR 1SEWP_GE DISPOSAL SYSTEM DISCONNECT PLUG AND 1ABANDON HOUSE SEWER I I I I I I 1BACKFILL SEPTIC TANKS _ ISEEP. PIT _ CESSPOOL GRAYWATER SYSTEM I I I I I i I I I I I I I I I I I I I I I i I I I II I I I i I I I I I I I I I I I 1 I I I I I i' ADDITIONAL DATA ON FILE IREPORT ID: DPR266 ROUTE TO BS0508 I I I I I I