HomeMy Public PortalAbout9018 HERMOSA DR_Sewer__ n ARTDEENT OF COUNTY ENGucum SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAF ET PERMIT APPLICATION
COUNTY OF LOS ANGEL S
' WILLIAM J. FOX. COUNTY ENGINEER BUILDING
"T ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING �/p x d/ 1% - NEAREST
ADDRESS l'' 44 !r jJ 117 ^ NEARCROSS ST.
LOCALITY
�. DISTRICT NO. SERIAL NO PERMIT NO.
Q_�
NEAREST `19A �� A 1D/ S
CROSS SL `��//
RECEIVED BY RendY,fac Inspection DATE ISSUED \ )
OWNER , '7 el 7�-
MAIL IVUSH 2I/O IN/E ,'I OCCUPANCYJAM An/"'
ADDRESS ilA./�Lw1..�Q_
BK PG
CITY TEL.NO.$fT 6-9.6 t`,', �—
CONTRACTOR CO.IMP.NO.
ADDRESS Ol��/ /e, S r 10B.NO. 4–
CITY TEL.NO./:_4 &401 0
TRUNK PERMIT N0. _
STATE
REGISTRATION NO. – COUNTY- B COUNTY
LEGAL
- ROAD PERMIT NO. `
DESCRIPTION LOT NO.f/N% STATE ENCROACHMENT v-
- PERMIT NO.
- BLOCK – TRACT _ INDUSTRIAL
WASTE APPROVAL,
SIZE OF LOT ,�/ ON LOTS _ CHARGES -
USE OF
BUILDINGS `�`—' CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK �`FE��
HOUSE SEWER CONNECTING TO _/' REIMBURSEMENT NO.ENT FEE DATE
RECEIPT
PUBLICSEWER- 0 S 3.50 U. I IBV
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR.._..- - EXCEPTION RECORDED
WORK TO HOUSE SEWER -1.00 NO.
ALTER OR REPAIR EXISTING I DATE BY
SEWERSEWER OR DISPOSALSYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM I.00 CONNECTIONS DATA
SEPTIC TANK,SEEPAGE PIT OR �
OIELO 2.00 STATION I'\ Q _DEPTH
C SSPOOLORYWELL
SPECIAL CONDITIONS ONLY 2.00 .(FFF---� ANHOLE REFERENCE
�.] UEEEB. LOWER
TVPEOFCONNE CTION LENGTH FRO -P-�
CURB -YL: M.L.-TO P.L.
OWNERS PERMIT ' $ 11 00
AUTHORIZATION TOTAL FEE 3�0 -
I'HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED -
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS--------------------DAY OF......._.._....._. ..._ 19...__. NEw HOUSE SEWER 29 7
OWNER OR - CONNECT ADDITIONAL /j 1
OWNERS AGENT./...3'-t- ....___...... 6BUILDING OR WORK
'ZZ
\ SEPTIC TANK,SEEP.PITS)
�ADORESS ........................._............... ANO/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL[ DRYWELL
'CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE.
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS. ALTER.REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED.
AND/OR LICENSED'AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND - a
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DES RIBED RESIDENTIAL PROPERTY. , BACKFILL SEPTIC TANKS E]
SIGNATURE SEEP.PIT(S)� CESSPOOLB� .L
OFPERMITTEE..._.. .. _...._............. ....._.._......_.._..._......_._.._. -
76A645D 663 1/53 - I
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 •SEWERfpERMIT
• DEPARTMENT OF PUBLIC WORKS - 9701 LAS TUNAS SE 0508 9912070007
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 a"'r ,
PHONE: (626) 285-0488 EXT:
LEGAL [D: SEWER / SEPTIC: S BUILDING.ADDR SS:
TR: 5905 LT: 125 EXIST OCC GRP: 9018'HERMOSA7,DRq
BLDGS. NOW ON LOT: TEMP CA,917801837
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST-CROSS-STREET: ROSEMEAD BLVD.
5387-014-022 ORIGINATION: THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
12/07/99 UT 06/04/00
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY CODE:
TRINH;KEN (626) 451-6827- JOB NUMBER: 7_tO,�
9018 HERMOSA DR TRUNK PERMIT NUMBER: 7-
TEMP 917801837 ROAD PERMIT NUMBER: �$CR PTION 0 WORK
AFFADAVIT: NO CONNECT NEW GUEST HOUSE TO PUBLIC SEWER SYSTEM
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET-WIDENING:
STATE EHA\VVIERM LT N`n'\�
CONTRACTOR: TEL. N0: 07 -FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO FE/D��IP.TIION: �Tj QUANTITY;UOM: AMOUNT: NEW HOUS SEWER ' y
01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
X19 CONN'ADDTNL_BLDG(S) 1,.00 EAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER: ILL. N0: / -TOTAL FEES 58.20
SEPTIC TANK, SEEPAGE PIT
LIC. NO: I 1111111 AND/OR DRAIN FIELD
L RYW L
SEWER MAP BOOK: PAGE: I �r \n n n C (1 n //O �/J [� ALTER, REPAIR, SEWER OR
Illll''/U ILIy IIS`-! V111Y1/ ILl7 `\1J SEWAGE DISPOSAL SYSTEM
DISCONNECT G A —
ABANDON HOUSE SEWER
SIJ Y
BACKFILL SEPTIC TANKS
t
SEEP. PIT _ CESSPOOL _
q u Q GRAYWATER SYSTEM
`b�rc Service That`N��
REPORT ID: DPR266 ROUTE TO BS05O8