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HomeMy Public PortalAbout5003 HELEO AVE_Sewer__ TEMPLE CITY CE80*8 D All 11 U�9/I"'ll II �®.Il Cl FOR PERMT CE808 8-SB /1'"9 /I-'U 11 COUNTY OF LOS ANGELES P®SAL. DEPARTMENT OF COUNTY ENGINEER . BUILDING AND SAFETY DIVISION' BUILDING JOHN A. LAMBIE. County Engineer ADDRESS &✓ CASSATT D. GRIFFIN. Sup't of Building • LOCALITY f. NEAREST FOR APPLICANT TO FILL IN CROSS ST Q tS' LEGAL . DESCRIPTION LOT N0. "'� � OWNER BLOCK TRACT /3 MAIL ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY °- USE OF r___7'T BUILDINGS - RICT NO. GROUPP PR CESSED BY CONTRACTOR:aa /�[jNECTION DATA CITY� f/ TEL.N0�' TION , ,L" DEPTH O�T ❑ CSTATE 'OUNTY MANHOLE REFERENCE REGISTRATION N0. ,LOWER ' NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO 9 PUBLIC SEWER' @$2e69 TYPE OF CONECTION LEN� FROM SEPTIC TANK,SEEPAGE PIT OR Y. CU 'P.L. M.L.IT P.La a� PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD s ' EXTN..CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO _ P.C.CO. PRIVATE DISPOSAL SYSTEM @ $1.00 r CO.IMP. N0. .JOB N CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $1.00 ! TRUNK PERMIT - OAD/PE MIT NO. - ALTER,REPAIR OR ABANDON HOUSE STATE ENCR CHMEN IV SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO ' - INDUST AL o WAST APPROVAL A GES OWNERS PERMIT $ 2 00 ONNE I !L ARGE F E AUTHORIZATION TOTAL FEE �� REIMBUR MENT FEE yy 1 HAVE AT THIS DATE A CONTRACT WITH THE. HEREIN MED CON- TRACTOR TO CONNECT -THE ABOVE DESCRIBED EXIST( G DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19__ NEW HOUSE SEWER OWNER.OR CONNECT ADDITIONAL t OWNERS AGENT BUILDING OR WORK ADDRESS '? SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD ' 1 HEREBY ACKNOWLEDGE 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. pLTER,REPAIR,SEWER OR SEWAGE DISPOSAL SYSTEM - F 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ' DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA'OR THAT AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEN L PROPERTY. BACKFILLSEPTICTANKS ❑ _ SIGNATURE SEEP. PITS) ❑ CESSPOOLS ❑ OF PERMITTED OF ALIDATION ROBERT A. WOOD CK. M.o. CASH SUPERVISING MECHANICAL ENGINEER Lay 0:�4;3 '5" SEP'2 0 'i O D 5.©0 . S&E•669 11.55 rl�I DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE ®0SP®SAL Department of County Engineer _, v 4.,, v County of Los_Angeles BUILDING .d ��-� �';1• , JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATTD. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN 3 CROSS ST. LEGAL - OWNER - h DESCRIPTION LOT NO. n BLOCK TRACT 3 iZ / AIL ADDRESS (� O NO. OF BLDGS. pk •. { SIZE OF LOT D NOW ON LOT CITY TEL. NO; USE OF r BUILDINGSatzk-v !!:''µ DISTRICT 0. I �G ..I MAP BK _ PG CONTRACTOR - � /�� ADDRESS `— 6 IN CONNECTION DATA ; CITY v TEL. NO. T / 2-, STATION DEPTH / MANHOLE REFERENCE UPPER ' ❑ STATE LOWER REGISTRATION NO. ❑ COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM PUBLIC SEWER @ .$3.50 Y• CURB P.L. A.L.TO P L. SEPTIC TANK,SEEPAGE PIT OR a PITS AND/OR DRAINFIELD @. $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. N0. EXTN.,CESSPOOL,DRYWELL,MANH0LE @ $2.00 - CO. IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT N0. - ROAD PERMIT,.NO. CONNECT ADDITIONAL BLDG.OR - STATE ENCROACHMENT WORK TO HOUSE.SEWER @ $1.00 f9O PERMIT N0. ALTER,REPAIR OR ABANDON HOUSE IN SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE.FEE OWNERS PERMIT $ 1 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE 00 P I HAVE AT THIS'DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS - DATE INSPECTORS SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED;EXISTINGUWELLING TO THE PUBLIC SEWER. �. NEW HOUSE SEWER SIGNED THIS DAY 0 —19 CONNECT ADDITIONAL OWNER OR - BUILDING OR WORK - 3� OWNERS AGENTS SEPTIC TANK,SEEP,PIT(S) ADDRESS V a 3 AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYW ELL❑ 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 ' 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT 1-AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL,PROPERTY. BACKFILL SEPTIC TANKS❑ LMIGNATURE / •�� - SEEP.PITS) ❑ CESSPOOLS❑ OF PERMITTEE�, /J• ilQ/�. JOHN A. LAMBIE, COUNTY ENGINEER mn VALIDATION ROBERMA. WOOD, CHIEF PLBG. INSPECTOR CK. Id.0. CASH tLO 8 7 9 0 jum 3 4 - 2.00 m COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1109130009 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 :PHONE: (626) 285-0488 EXT: ILEGAL ID: (SEWER / SEPTIC: SEWED. BUILDING ADDRESS: ITR: 13329 LT: 5 BL: .001 IEXIST OCC GRP: 5003 HELEO AV I IBLDGS. NOW ON LOT: ASSESSOR INFORMATION NUMBER: TEMP CA 917803825 I CONNECTION TYPE: � NEAREST CROSS STREET: 1 18590-023-024 (ORIGINATION: ,I THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY, Cl LENGTH ML TO PL: STATION: DEPTH: (TENANT: IMANHOLE REFERENCE: UPPER/LOWER: 11SSUED ON: PROCESSED BY: I i 109/13/11 SR I I ICOUNTY IMPROVEMENT NUMBER: OWNER: TEL. NO: IPLAN CHECK NUMBER: IF AL DATE FINAL BY: CODE: IHENDERSON ROBERT B;ELIZABETH A (818) 287-8219- IJOB NUMBER: 15003 HELEO AV TRUNK PERMIT NUMBER: i -to- I ITEMP 917803825 IROAD PERMIT NUMBER: IDESCRIP ION OF WORK 1 IAFFADAVIT: NO (INSTALL 4" CLEAN OUT IN YARD I I 1WAIVER: NO 1APPLICANT: TEL. NO: 1EASEMENT: NO 1 I IPAYLESS 4 PLUMBING (800) 220-0209- 1 IRECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS: I (HIGHWAY/STREET WIDENING: ISTATE ENCROACHMENT PERMIT NUMBER: I 1 I ICONTRACTOR: TEL. NO: ,1 FEES PAID IAPPR©ALS DATE INSPECTOR SIGNATURE I IPAYLESS 4 PLUMBING, INC. (800) 220-0209- 1 - I 19911 PARAMOUNT BLVD #305 LIC. NO IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: INEW.HOUSE SEWER I 1 IDOWNEY CA 90241 817084 C36 1 - 101 PERMIT ISSUANCE FEE 27.80 ICONNECT ADDITIONAL I 1 115 ALT/REP HOUSE SEWER 1.00 EAC 30.40 IBUILDING OR WORK I 'I (ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.20 1 1 - I ISEPTIC TANK, SEEPAGE PITI I I 1 LIC. NO: I 1AND/OR DRAIN FIELD I IDRYWELL I I- SEWER MAP BOOK: PAGE: 1 IALTE'R, REPAIR, SEWER OR I I ISEWAGE DISPOSAL SYSTEM I � I I I I I IDISCONNECT PLUG AND I 1 1ABANDON HOUSE SEWER I I I . IBACKFILL SEPTIC TANKS I 1 1 ISEEP. PIT - CESSPOOL I I 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 I I 1 IREPORT ID: DPR266 ROUTE TO BS0508