HomeMy Public PortalAbout9828 KEY WEST ST_Sewer__ _Bi
76A642D �'�]APPLICATION FOR PERMIT
76A 642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
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JOHN A, LAMBIE. County Engineer ADDRESS p� ')
WILLIAM A. JENSEN, Supt of Building LOCALITY
NEARE
FOR APPLICANT TO FILL IN
CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL NO
USE I
BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY
Bim, Pd
CONTRACTOR 0 n/ f r
ADDRESS CONNECTION DATA
CITY TEL.N0. S �., STATION DEPTH
STATE MANHOLE REFERENCE ✓ LOWER
REGISTRATION NO. COUNTY
N0. 1 DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 00 < TYPE OF CTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. URB P.L. M L.TO P.L.
PITS AND/OR DRAINFIELD 5 00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN CESSPOOL DRTWELL @ 00 }
a
HOUSE SEWER CONNECTING TO P.C NO. O
PRIVATE DISPAL SYSTEM @ S 00 CO IMP NO JOB NO. V
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. pm
WORK TO HOUSE SEWER @ S 00 O
SEWER REPAIR
R DISPOSAL ABANDON HOUSE @ $1 00 STATE ENCROACHMENT G
EM PERMIT NO
INDUSTRIAL 17J
WASTE APPROVAL
to
CHARGES Z
OWNEWS PERMIT E 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE 1 INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. /�gyipp C J
SIGNED THIS > D 19_ NEW HOUSE SEWER
OWNER OR a CONNECT ADDITIONAL ✓ t.�
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP PITS))
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE REVD THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER / A
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP PITS ❑"CESSPOOLS
OF PERMITTE
VALIDATION ROBERT A. WOOD
Cs. tl 0. CASH SUPERVISING MECHANIC"ENGINEER
LIQ
7i 7 0 1 ,`iI Ft 1. �i p 267.0 L/
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS CSE 0508 9901110004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL SE SEPTIC: X BUILDINGDRESS:
TR: 14908 LT: 8 EXIST OCC GRP: 9828 KEY WEST ST
BLDGS. NOW ON LOT: TEMP CA 917803918
CONNECTION TYPE:RIN ORM ON NEAREST CROSS STREET:
8589-021-018 ORIGINATION: THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TE MANHOLE REFERENCE: UPPER/LOWER: ISSUED N: PROCESSED EXPIRES PW.
COUNTY IMPROVEMENT NUMBER: 01/11/99 UT 01/11
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
MCCLELLEN HOLLY A - JOB NUMBER:
9828 KEY WEST ST TRUNK PERMIT NUMBER:
TEMP 917803918 ROAD PERMIT NUMBER: DESCRIPTION
AFFADAVIT: NO fINST{1LLION OF 4" C ST IRON CLEAN0 SIDE-OF HOUSE
WAIVER: NO
APPLICANT: . 0: EASEMENT: NO
RAPID PLUMBING (800) 997-2743-
1746 ALALONE AVE RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
TORRANCE, CA HIGHWAY/STREEToWIDENING:-�
STATE ���HM�E�NI�P�MIT���\�
CONTRACTOR: TEL. NO: ®� \�\ APPROVALS DATE INSPECTOR SIGNATURE
RAPID PLUMBING (800) 997-2743- d
1746 ABALONE ST LIC. NO FEE DESCR_I'P-TION: QUANTITY: UOM: AMOUNT: SEWER
TORRANCE CA 90501 BUS LIC. * �
01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
1115 ALT/RE P HOUSE SEWER1.00 EAC 30.45 BUILDING OR WORK
AR E L. a TOTAL FEES 58.20
SEPTIC TANK, SEEPAGE PIT
t LIC. N0: 1111111 AND/OR DRAIN FIELD
ELL
SEWER MAP OOK: PAGE: RUB" UC W
O�K
LE}T��ERGE Rq��P,?AOIRS, SEWER0 ILir lu� S%lam (E�-'►'IftAL Z
DIS ON T PL G-ANV
O 0 ABANDON HOUSE SEWER
D rFf BACKFILL SEPTICTANKS _
a SEEP. PIT _ CESSPOOL _
�O Cl ® w ®y GR TER SYSTEM
0 �
48�, of
/c Service Th2"t
* ADDITIONAL DATA ON FILE
REPORT ID: DPR266 ROUTE TO BS0508