HomeMy Public PortalAbout6119 IVAR AVE_Sewer__ 24650 INSERTS, ,
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COUNTY OF LOS ANGELES SEWER—SEWAGE .®O SPOSAL
DEPARTMENT OF COUNTY ENGINEER F
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 NO. & 0 g / 7—
BLOCK
OWNER
BLOCK TRACT _ � L� MAIL -
ADDRESS
NO.OF BLDGS.
SIZE OF LOT - NOW ON LOT CITY TEL. NO. "
USE OF
BUILDINGS ., DISTRICT NO. GROUPI MAP PROCESSED By
CONTRACTOR
BK PG I
ADDRESS S' 7— CONNECTION DATA
CITY TEL.N0. 0 . STATION s 3� DEPTH
STATE . MANHOLE REFERENCE `UPPER '
REGISTRATION NO. ® COUNTY
No. DESCRIPTION OF Wolk EE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00TYPE OF TION - LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. 'M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00 _
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2200
HOUSE SEWER CONNECTING TOP.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. ' _ JOB NO.
CONNECT ADDITIONAL BLDG.OR '.TRUNK PERMIT N0. ROAD PERMIT N0. p
WORK TO HOUSE SEWER @ $1.00 U
SEWER OR DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT D;
' PERMIT NO. 0
INDUSTRIAL U
WASTE APPROVAL - W
P.
CHARGES
OWNER'S PERMIT o $ 21 00 CONNECTION CHARGE FEE
5 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
T
RACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECT R'S SIGNATURV
TO'THE PUBLIC SEWER.
a SIGNED THIS DAY OF 19— ° NEW HOUSE SEWER �2 /
OWNER OR CONNECTADDITIONAL
OWNERS AGEN o�f./ R9� BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY,ACKNOWLEDGE THATA HAVE READ THIS APPLICATION ••
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ,. CESSPOOL Cl DRYWELL ❑ y
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ` ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. Y SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT .1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ,k. ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE NTIA P OPERTY. tj BACKFILL SEPTIC T=o
ANKS ❑
SIGNATURE - SEEP. PIT(S) CESSPOOLS 6l CP(
OF PERMITTEE
`
_
®rVALIDATIO ROBERT A. WOOD
cK ta.o. GSR SUPERVISING MECHANICAL ENGINEER
COUNTY•OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0201280008
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
GAL ID: SEWER / SEPTIC: Y BUILDING ADDRESS:
TR: 5904 LT: 17 EXIST OCC GRP: 6119 IVAR AV
BLDGS. NOW ON LOT: TEMP CA 917801524
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: LONGDEN
5386-010-059 ORIGINATION: THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
01/28/02 JK 07/27/02
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
HUNG; GLORIA .(626) 583-8968- JOB NUMBER: �z� 0
6119 IVAR AVENUE TRUNK PERMIT NUMBER:. �^
TEMPLE CITY 91780 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO CONNECT ADDITION TO SEWER
WAIVER: NO .
APPLICANT: TEL. NO: EASEMENT: NO
SAME AS OWNER
RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER
LIC. NO FEE DESCRIPTION: QUANTITY: UOM:, AMOUNT: NEW HOUSE SEWER
01 PERMIT ISSUANCE FEE' '- 27.75 CONNECT ADDITIONAL
13 WORK TO:HOUSE -SEWER 1.00 EAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. NO: - -- NOTAL FEES 58.20
I SEPTIC TANK, SEEPAGE PI
LIC. NO: - - AND/OR DRAIN FIELD
DR WELL
SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG KAU
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS _
SEEP. PIT CESSPOOL
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO BS0508