HomeMy Public PortalAbout10217 LA ROSA DR_Sewer__ C76A6BOe 13.e8 eSZO APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING T7
JOHN*A. LAMBIE, COUNTY ENGINEER ADDRESS
COLEMAN W. JENKINS. SUPT. OF BUILDING j'''am
LOCALITY �j-/�F L,/T `/�Ze�
CROESB6T.
FOR APPLICANT TO FILL IN G
AL I
DESC RCPTION LOT NO. OWNER
MAIL
BLOCK TRACT AD MAORE66
NO. OF SLOGS, yy3 T-.-S
SIZE OF LOT NOW ON LOT CITY TEL. NO. Z
USE OF C f� pI6TRICT NO. GROUP MAP PROCESSED BY
BUILDINGg LJ y- / [
�% l�C� 5
K PC
� 6
CONTRACTOR
ADDRESS /�. /Q /.�p K d'y CONNECTION DATA
CITY ��� TEL. NO. �gJZSr STATION S C DEPTH
LICENSE Nps (Zxl� xS .� CLA SB C TATE / Z MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE TYPE OF CTION LENGTH FROM
HOUSE SEWER CONNECTING TO ! Y. p.L. M.L.TO P,L.
PUBLIC SEW ER ® E5.Do �J OC�
SEPTIC TANK,SEEPAGE PIT OR �j P.C.NO.
PITS AND/..GRAINFIELD Q SIO.GO CO.IMP. NO. `^O 2 J JOB NO. /J
HOUSEBEWER C ONNECTING TO TRUNK PERMIT NO.J ROAD PERMIT NO. 7 �9 >'
PRIVATE DISPOSAL SYSTEM $3.00 6.
CONN ECT ADDITIONAL BLDG.OR AFFIDAVIT uv [n5[x[xt RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER Q $3.00 U
OVERFLOW SEEPAGE PIT.GRAINFIELD C
EXTN..CESSPOOL.ORYWELL.MANHOLE $500
ALTER.REPAIR OR ASSHOUSE V
SEW Eq OR DISPOSAL SYSTEM
HWY.OR ST.WIDENING
M Q 13.00 STATE ENCROACHMENT CL
PERMIT NO.
INDUSTRIAL Z
I WASTE APPROVAL
FeRMrr s z GD
OWNOWNER'SAUTHORIZATION TOTAL FEE ma CONNECTION CHARGE FEE CHARGES
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO,CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC q.� APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAV OF I9,�y '� -^/ IV `
OWNER A /ff fJ1 � NEW HOUSE SEWER
OWNERS AGENT— • • [
,—� o CONNECT ADDITIONAL
ADDRESB HOZ /'T'� � C.�/ /AOS �i(� BUILDING OR WORK
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPT IC TANK.SEEP,PITIS]
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLV '[ND/OR DRAINFIELO
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ro
PL U NOING AND SEWERS. CESSPOOL ❑ ORYWELL ❑
I HEREBY CERTIFY THAT I wM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AS REO LOS ANGLES COUNTY AND STATE OF EEWAG E DIS POBA L!YET E MALI q A 4
RESIDE RIN 1w TOR AT 1 ESCRIBEEHE D RE OD HER
RIA 01.RAONPpE RI HYE NO TO OIBCO NNECT PLUG AND
/ 17,
I I �� � ,
ABANDON HOUSE SEWER /ISR I
SIGNA BACKFILL SEPTIC TANKS ❑ V I �/ _
O E SEEP.PIT 151 ❑ CESSPOOLS ❑ I,
VALIDATION K RJACK ALLEN
CK. M.o, CASH SUPERVISING KMECHANICAL ENGINEER
I pl( 6 5 5 4 AUG31 1 0 0 7.00- v
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0004280001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER / SE TIC: SEWER BUILDING ADDRESS:
TR: 13531 LT: 3 EXIST OCC GRP: 10217 LA ROSA DR
BLDGS. NOW ON LOT: TEMP CA 917803307
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: BALDWIN
8585-006-003 ORIGINATION: THOMAS PAGE: 597 GRID: B4 LOCALITY: TEMPLE CITY, C
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: XPI ES ON:
04/28/00 VG 10/25/00
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL.-NO2 PLAN CHECK NUMBER: FINAL DATE FINAL 8Y: 4ODE:
MORTON WEBSTER G;EDITH R (626) 443-3-2528- JOB NUMBER: //-fir'_O /-/-A/
10217 LA ROSH DR TRUNK PERMIT NUMBER: `
TEMP 917803307 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO CONNECT ADDITIONAL WORK TO HOUSE SEWER
WAIVER: NO
APPLICANT: EL. NO: EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET-WIDENING:
STATE ENCROACHMENT:P.ERMIT:NUMBER:
CONTRACTOR: TEL. NO: 7 FE S`.A D APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER - / '(0
LIC. NO FEE,DESCRIPT ION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER
01
01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
/ 13 WORKATO/HOUSE'SEWER 1.00 EAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. NO: // TOTAL FEES 58.20
SEPTIC TANK, SEEPAGE PIT
LIC. NO: 111 ilu AND/OR DRAIN FIELD
DRW L _
SEWER MAP BOOK: PAGE: I F- �(1 M'LOU' (� �C C\ n //On,/J [tom ALTER, REPAIR, SEWER OR
IIJI UILIA \ll/II\l1'YIl w IUIC�\1 C\J�J SEWAGE DISPOSAL SYSTEM
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DISCONNECT PLUG AND
ABANDON HOUSE SEWER -
Uk y" SII
BACKFILL SEPTIC TANKS
Q ❑ - SEEP. PIT _ CESSPOOL _
q ❑ ®_� ®g GRAY A ER SYSTEM
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REPORT ID: DPR266 ROUTE TO BS0508