HomeMy Public PortalAbout10520 KEY WEST ST_Sewer__ E-6D
8& 89 11-SS APPLICATION FOR PERMIT
8 8 E•8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer /
County of Los Angeles AD RE BUILDINSG •oS t7a$
JOHN A LAMBIE, COUNTY ENGINEER _
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY j
FOR APPLICANT TO FILL IN C..S ST
DESCRIPTION LOT NOLEGAL I& qT yJ U 3*81 OWNER E5Lcjjjj)her" ,3,0yp
BLOCK �_ TRACTMAIL
I/ _!ToADDRESS /�.S.Z D Ky �tl 'r�OD
SIZE OF LO ` .y N0.OF BLDGS T p errs 877 3.y
,/ NyOW ON LOT �+ CITY TEL NO
USOF
BUILDINGS Y 9Y� y d" �^ DISTRICT NO GROUP MAP I
BK PG
CONTRACTOR 40
vc
ADDRESS CONNECTION DATA
STATION DEPTH
CITY TEL.NO.
MANHOLE REFERENCE UPPER
❑ STATE LOWER
REGISTRATION NO ❑ COUNTY - L�
NO DESCRIPTION OF WORK FEE J
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM _
PUBLIC SEWER ,'��a
@ $350 Y. CURB PL M L TOPL.
SEPTIC TANK,SEEPAGE PIT OR x
PITS AND/OR DRAINFIELD @ $3 00 v
OVERFLOW SEEPAGE PIT,DRAINFIELD P C. NO.
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO
A&ZZa-L&BA4i"-"ABANDON HOUSE '
NDUSTRIAL
DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
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
I 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 I AM THE LEGAL OWNE F THE BOVE
DESCRIBED RESIDENT;4L PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE SEEP PIT(S) ElCESSPOOLS[I i
OF PERMITTEE ' /
JOHN A LAMBIE. Cou Y ENGINEER VALIDATION R(58ERT A WOOD, CHIEF LBG INSPECTOR
CK d O CASH
L O2 1 9 0� N 2 4 4 A 2..00
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0301030002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
SEWERLEGAL ID: BUILDING AD
TR: 11290 LT: 1 BL: .001 UN: .002 EXIST OCC GRP: 10520 KEY WEST ST
BLDGS. NOW ON LOT: TEMP CA 917803462
ASSESSORORMAT ER: CONNECTION TYPE: NEAREST CROSS STREET: HALIFAX
8585-024-004 ORIGINATION: THOMAS PAGE: 597 GRID: C4 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED 0 PROCESSED B : EXPIRES 0
01/03/03 JK 07/02/03
COUNTY IMPROVEMENT NUMBER:
OWNER: TE 0: PLAN CHECK NUMBER: FINAL ATE FINAL BY: CODE:
HENSLY; JOHN - JOB NUMBER:
10520 KEY WEST ST TRUNK PERMIT NUMBER: 6 (jam
TEMP 917803462 ROAD PERMIT NUMBER: SCR ON OF WORK
AFFADAVIT: NO CONNECT SFR TO SEWER r
WAIVER: NO
APPLICANT: L. 0: EASEMENT: NO
SIEMPRE CONSTRUCTION INC (626) 792-3727-
1827 SAN PASQUAL ST RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITION :
PASADENA 91107 HIGHWAY/STREET WIDENING
STATE ENCROACHMENT PERM I,T-NUMBER:
CON RACTOR: TEL. NO: \F E -PA D APPROVALS DATE INSPECTOR SIGNATUR
SIEMPRE CONSTRUCTION, INC. (626) 792-3727-
1827 SAN PASQUAL STREET LIC. NO FEE/DESCRIPTION: QUANTITY: UOM: AMOUNT: W HO ER
PASADENA, CA 91107 805704 B // Ar c
01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
03 CONN 0 PUBLICVSEWER 1.00 CON 46.95 BUILDING OR WORK
ARCHITECT-ORENGINEER: L. 0: / TOTAL FEES 74.70
SUNSHINE DESIGN ASSO (626) 289-6300SEPTIC T AG
301 N. ROSEMONT BLVD. LIC NOj� 1111111 AND/OR DRAIN FIELD
SAN GABRIEL, CA 91775 NONE
� DRYWELL _
SEWER MAP BOOK: AGE: �,n n O L�C t, n n�,-�1 Ho' � ALTER, REPAIR, SEWER R
\\�"///�\�1 ��jU^U< IK`v SEWAGE DISPOSAL SYSTEM
— — DISCONNECT PLGG A
O Q ABANDON HOUSE SEWER
D BACKFILL SEP _
SEEP. PIT _ CESSPOOL _
nIIn=
GRAYWATER SYSTEMGRAY
REPORT ID: DPR266 ROUTE TO BS0508