HomeMy Public PortalAbout4906 HELEO AVE_Sewer__ I _
S&E-B 63 11-55 APPUC TO N FOR PERIlb7D0T
DIVISION OF BUILDING AND SAFETY SEW E D-SEWAG E DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING ��iO l Al.
/ ���y
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ` V A V
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY 77,' G
FOR APPLICANT TO FILL IN :R srAREST
or .
LEGL
DESCRIPTION LOT NO. OWNER i ca
MAIL
y,. BLOCK TRACT - ADDRESS
NO. OF BL GS. CITY TEL. NO.
SIZE OF LOTS -.- NOW 0 LOT
USE OF
BUILDINGS DISTRICT N0. GROUP r MAP
BK PG
CONTRACTOR - r
`} ADDRESS a CONNECTION'DATA
STATION � 7 2 DEPTH _
CITY TEL. NO. yt. MANHOLE REFERENCE UPPE
STATE __ - �� 3 LOWER
REGISTRATION NO. / COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNE T N LENGTH FROM ..
Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR.DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD y CO. IMP. NO. JOB N C. O
EXTN.,CESSPOOL,DRYW ELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO � e)
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT N0. ' ROAD PERMIT NO. l /
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 $ 1 00 iv V
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT 'THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTORSSIG ATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED E)ISTING DWELLING
TO THE PUBLIC SEWER. - _ NEW HOUSE SEWER ..J
'SIGNED THIS AY O � 1 CONNECT ADDITIONAL-
OWNER OR - BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
_ADDRESS < AND/OR DRAINFIELD -
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY '.
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM'
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR R DISCONNECT PLUG AND
LICENSED AS REQUIRED V LOS ANGELES COUNTY AND STATE OF gggNDONHOUSESEWER
CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDENT ROPERTY. BACKFILL SEPTIC TANKS❑
" SIGNATURE k SEEP.PIT(S) ❑ CESSPOOLS /
OF PERMITTEE `
JOHN A. LAM9&. COUNTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. ASl� '
2.l 7 t AR 19 4 A 4-50
AvIc
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1401130008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: ISEWER / SEPTIC: SEWER 1 BUILDING ADDRESS:
ITR: 13329 LT: 28 _ IEXIST OCC GRP: 4906 HELEO AV
I IBLDGS. NOW ON LOT: TEMP CA 917803822
(ASSESSOR INFORMATION NUMBER: ICONNECTION TYPE: NEAREST CROSS STREET: LOWER AZUSA
18590-021-020 (ORIGINATION: I THOMAS PAGE:-596 GRID: JS LOCALITY: TEMPLE CITY CAI
I ILENGTH ML TO PL: STATION: DEPTH: I
(TENANT: IMANHOLE REFERENCE: UPPER/LOWER: (ISSUED ON: PROCESSED BY:
1 1 101/13/14 SR
ICOUNTY IMPROVEMENT NUMBER: I
(OWNER: TEL. NO: IPLAN CHECK NUMBER: IFINAL DATE FINAL BY: CODE:
ILIU, WEI LING (626) 286-2065- IJOB NUMBER: I / (/����/
14906 HELEO AV ITRUNK PERMIT NUMBER: 1 ( 2 4/ 1\
ITEMP 917803822 IROAD PERMIT NUMBER: IDESCRIPTION OF WORK I
IAFFADAVIT: NO IREPLACE SEWER LINE @ FRONT LAWN I
'_IWAIVER: NO I
(APPLICANT: TEL. NO: (EASEMENT: NO - I
ISAME AS OWNER - 1 1
I IRECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS: 1
1 IHIGHWAY/STREET WIDENING: 1
ISTATE ENCROACHMENT PERMIT NUMBER: 1
I I I 1
(CONTRACTOR: TEL. NO: FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE
ISAME AS OWNER - I Ij
LIC. NO :FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: INEW HOUSE SEWER I
1 101 PERMIT ISSUANCE FEE 27.80 ICONNECT ADDITIONAL
1 115 ALT/REP HOUSE SEWER 1.00 EAC 30.50 IBUILDING OR WORK 1 I
(ARCHITECT OR ENGINEER: TEL. NO: j _TOTAL FEES 58.30 1 I
1 ISEPTSC TANK, SEEPAGE PITI I I
LIC. NO: IAND/OR DRAIN FIELD 1 1 I
IDRYWELL
1 SEWER MAP BOOK: PAGE: (ALTER, REPAIR, SEWER OR I I I
1 ISEWAGE DISPOSAL SYSTEM j
1 I IDISCONNECT PLUG AND 1
(ABANDON HOUSE SEWER I I I
I IBACKFILL SEPTIC TANKS
' ISEEP. PIT _ CESSPOOL
I IGRAYWATER SYSTEM 1 I 1
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1 IREPORT ID: DPR266 ROUTE TO BS0508 I I I I