HomeMy Public PortalAbout9842 KEY WEST ST_Sewer__ D
CE808-a•sa - APPLICATION' F'OR - PERMIT
fieoe• COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS `
y JOHN A. LAMBIE, County Engineer I _
CASSATT D. GRIFFIN. Supt of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN ceoss ST
LEGAL
DESCRIPTION LOT N0. OWNER �'
MAIL
BLOCK TRACT ADDRESS
0 OF BLDGS.
SIZE OF LOT NOW ON LOT CITY ~� TEL NO
USE OF
BUILDINGS ��—} f— FN MAP PQ PROCESSED BY
�i�ls. �K q2 I
CONTRACTOR �ADDRESS � ��' CONNECTION DATA
CITY" N0. a ��/ DEPTHSTATECE ' 411PPERREGISTRATION NO �y COUNTY LO RNO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $8.00 9SEPTIC TANK,SEEPAGE PIT OR ION -LENGTH FROMPITS AND/OR DRAINFIELD @ $8 00 P.L. M L.TO P L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00
HOUSE SEWER CONNECTING TOP.C. N0.
PRIVATE DISPOSALS EM @ $1 00 CO.IMP.N0. JOB NO
WORK '42DD TI N BLDG f ��j TRUNK PERMIT NO. ROAD PERMIT NO. C�LG�L
SEWER OR DISPOSAL SYSTEM HOUSE $1 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL -
WASTE APPROVAL
1 CHARGES
OWNER'S PERMIT i 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWS
SIGNED THIS SAY OFA% 19� NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT / , L'C - .�/ �— BUILDING OR WORK
�c J SEPTIC TANK,SEEP,PIT ISI
ADDRESSAND/OR DRAINFIELD
t HEREBY ACKNOWLEDGE THAT I HAVE READ 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 T 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 OWNER OF THE ABOVE
DESCRIBED RESIDENTIALL�FRO/PERTY./ BACKFILL SEPTIC TANKS❑
SIGNATURE �'/ f / �c���--- �J�� SEEP.PITS` CESSPOOLS❑
OF PERMITTEE I��� ��� I� `�'7/,
®r V ATION ROBERT A WOOD
Gulf SUPERVISING MECHANICAL ENGINEER
LG 3 7 1 OCT' 8 1 0 A 6.0 0
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1008250003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
ILEGAL ID )SEWER / SEPTIC SEWER BUILDING ADDRESS
ITR 13986 LT 17 BL 001 UN 002 SEXIST OCC GRP 1 9842 KEY WEST ST I
I IBLDGS NOW ON LOT TEMP CA 917803918
IASSESSOR INFORMATION NUMBER ICONNECTION TYPE I NEAREST CROSS STREET GOLDEN WEST I
18589-021-008 (ORIGINATION I THOMAS PAGE 597 GRID A4 LOCALITY TEMPLE CITY, Cl
(LENGTH ML TO PL STATION DEPTH
)TENANT IMANHOLE REFERENCE UPPER/LOWER IISSUED,ON PROCESSED BY I
I 108/25/10 SR
I
ICOUNTY IMPROVEMENT NUMBER
(OWNER TEL NO IPLAN CHECK NUMBER IF AL PATE FI BY CODE I
IEMANUELLI, JOHN (626) 286-5262- )JOB NUMBER I 1
19842 KEY WEST ST TRUNK PERMIT NUMBER V�j
ITEMP 917803918 IROAD PERMIT NUMBER IDESCRIPTION OF WORK I
I IAFFADAVIT NO IREPLACE 40" OF SEWER 1
1 )WAIVER NO 1 I
(APPLICANT TEL NO (EASEMENT NO I )
1D0NDALSKI, JOHN (909) 618-4610- 1 I
IRECORD INSTRUMENT NBR RECORD DATE ISPECIAL CONDITIONS
I HIGHWAY/STREET WIDENING I I
ISTATE ENCROACHMENT PERMIT NUMBER I I
I I I I
ICONTRACTOR TEL NO I FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE 1
ILITTLE JOHN'S PLUMBING (909) 618-4610- I 1 I
12373 2ND STREET LIC NO IFEE DESCRIPTION QUANTITY UOM AMOUNT INEWIFOUSE SEWER
ILA VERNE, CA 91750 628921 C36 I I I I I I
I 101 PERMIT ISSUANCE FEE 27 80 ICONNECT ADDITIONAL
1 113 WORK TO HOUSE SEWER 1.00 EAC 30 40 IBUILDING OR WORK /i7 oI or
(ARCHITECT OR ENGINEER TEL NO I TOTAL FEES 58 20 I
I - i ISEPTIC TANK, SEEPAGE PITI I
LIC NO IAND/OR DRAIN FIELD 1 I I
I I IDRYWELL _ I I I
I I- I
1 SEWER MAP BOOK PAGE I )ALTER, REPAIR, SEWER OR I I 1
1 ,I ISEWAGE DISPOSAL SYSTEM I I
I I I I I I
IDISCONNECT PLUG AND 1 1
IABANDON HOUSE SEWER I I I
I I I • I I I
1 I 1BACKFILL SEPTIC TANKS _I I
I ISEEP PIT _ CESSPOOL
I I 1GRAYWATER SYSTEM
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