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DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 1
COUNTY OF LOS ANGELES
WILLIAM J. FDX. COUNTY ENGINEER BUILDING ���� ve'
CASSATT D.-GRIFFIN. SUPT OF BUILDING ADDRESS �y f //d
FOR�A/PPLICANT TO FILL IN LOCALITY TO-
BUILDING
ADDRESS ✓ / a-� NEAREST '
,3 yf2.✓ - CROSS ST. / hyPS DI-
LOCALITY 1 DISTRICT N0. SERIAL NO. PERMIT NO.
�7� o , �. S A 43'49 I ,qzo
NEAREST ��— /jA �' n
CROSS'ST. r +-V
y , REG IVF Y Ready for Inspection DATE ISSUED
OWNER I ' 77 l- ;7-6-
MAIL USE20NE I OCCUPANCY MAP
ADDRESS - ✓ ` BK PG
CITY I
;1 TEL.NO./�ZT /y J'•) Z(I. J
CONTRACTOR/ 01 � CHARGES REIMBURSEMENT FEE
'n1 1 . REQUIRED -7
ADDRESS (il+
NOT REQUIRED
CITY
TEL.1 0 L �c(�Q'�7�� JOB NO. 4 f 6 �' /,� CONNECTION CHARGE FEE
STATE CO.IMP. NO.
REGISTRATION NO. Z/3040/5 Cau*w
LEGAL RECEIPT NO. DATE BV
DESCRIPTION LOT NO. �� I��
BLOCK TRACT / ZU 7 WAIVER FOR RECORDING
SIZE OF LOT N0.OF eLOGS. //JJ
NOW ON LOT RECEIPT NO. I DATE
USE IBV
(iL -_-_
r
BUILDINGS TRUNK PERMIT-NO. ---- ---NO. DESCRIPTION OF WORW1 FEE 114
HOUSE SEWER CONNECTING TOROADPERMITND. _------
PUBLICSEWER (9 $ 3.50 3 0
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSAL SYSTEM 1.00 PERMIT NO. --
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL - --
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND AND/OROSPOSAL SVABANDON SEWER
STEM1.001
STATION ? 7L-47 a DEPTH e
SEPT ICTANK,SEEPAGE PIT OR
PITS ANO/OR DRAINFIELD 2.00 MANHOLE REFERENCE '//
CESSPOOL—DRV WELL U LOWER_2 A/
SPECIAL CONDITIONS ONLY 2.00 TYPE OF CONNECTION LENGTH FROM
-CURB. P.L. M.L.TO P.L.
OWNERS PERMIT $ I 1 00 —
AUTHORIZATION I TOTAL FEE I 41-5'42
I HAVE THIS DATE CONTRACTED WITH THEI HEREIN NAMED
CONTRATOR
SIGNED
I FILING TO THE PUBLIC SEWER ` , 1 C� 14.?—.3 CONNECT
OR WORK
TURF DATE
OWNER OR TO CONNECT DAY OF�E DE��ED;XISTING APPROVALS INSPECTOR'S SIGNATURE ^�
OWNERS AGEXT .....__....._......_..__..._------._.. _----- PIT(S)AND/OR DRAINFIELD
T
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 ORYWELL C]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
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 AND
ABANDON HO PLUG PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]
SIGNATURE � � j �• p - I SE EP.PIT(S)� CESSPOOLS
OFOF PER
PERMITTEE.._..._._.._L......._....._......_..............._. ...................
76A542D 663 12/62
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
' DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1211010006
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: (SEWER / SEPTIC: SEWER BUILDING ADDRESS:
ITR: 17387 LT: 10 IEXIST OCC GRP: 5432 HILTON AV
I BLDGS. NOW ON IAT: TEMP CA 917803122
(ASSESSOR INFORMATION NUMBER: ICONNECTION TYPE: NEAREST CROSS STREET:
18588-029-002 (ORIGINATION: THOMAS PAGE: 596 GRID: J4 LOCALITY: TEMPLE CITY CAI
ILENGTH ML TO PL: STATION: DEPTH:
(TENANT: (MANHOLE REFERENCE: UPPER/LOWER: (ISSUED ON: PROCESSED BY:
111/01/12 SR
ICOUNTY IMPROVEMENT NUMBER: I
TOWNER: TEL. NO: IPLAN CHECK NUMBER: IFIVAL DATE FINAL BY: CODE:
SENSCOTER HAZEL C (626) 286-1425- (JOB NUMBER: 1 1
15432 HILTON AV TRUNK PERMIT NUMBER: I \ I
TEMP 917803122 (ROAD PERMIT NUMBER: DESC IP ION OF WORK I
AFFADAVIT: NO IREPAIR SEWER LINE ON THE PRIVATE PROPERTY I
I IWAIVER: NO I I
(APPLICANT: TEL. NO: (EASEMENT: NO I
IHADAR, PERETZ (818) 395-5113- 1 1 1
12101 LAS LOMITAS DR IRECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
I HACIENDA HEIGHTS IHIGHWAY/STREET WIDENING: I
I ISTATE ENCROACHMENT PERMIT NUMBER: I
I I I
1CONTRACTOR: TEL. NO: I FEES PAID 1APPROVALS DATE INSPECTOR SIGNATURE I
IRIGHT ON TIME PLUMBING INC (818) 644-2389- I 1
18439 CARPENTER AVE LIC NO IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT: INEW HOUSE SEWER I
IVALLEY VILLAGE CA 913366 - I II
1 101 PERMIT ISSUANCE FEE 27.80 ICONNECT ADDITIONAL
115 ALT/REP HOUSE SEWER 1.00 EAC 30.50 IBUILDING OR WORK I
(ARCHITECT OR ENGINEER: TEL. NO: 1 TOTAL FEES 58.30 1
- I ISEPTIC TANK, SEEPAGE PITI
LIC. NO: I AND/OR DRAIN FIELD
I I I
I IDRYWELL
1
I
SEWER MAP BOOK: PAGE: 1 (ALTER, REPAIR, SEWER OR I I I
I ISEWAGE DISPOSAL SYSTEM
I
(DISCONNECT PLUG AND 1 1
ABANDON HOUSE SEWER
I
IBACKFILL SEPTIC TANKS T
(SEEP. PIT _ CESSPOOL I
T GRAYWATER SYSTEM
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I 1' ADDITIONAL DATA ON FILE
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1 (REPORT ID: DPR266 ROUTE TO BS0508
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