HomeMy Public PortalAbout6453 LIVIA AVE_Sewer__ 70A642 D
9&E-6633.55 APPLICATION
FOR
PERMIT ERpI .
1
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
Department of County Engineer xamFJ2=
County,of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS y
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITYNEAREST 7�zol
(� •��T
FOR APPLICANT TO FILL CROSS ST.
LEGAL f
DESCRIPTION, LOT NO
BLOCK TRACT MAIL
ADDRESS
NO OF BLDGS. �r
SIZE OF f NOW ON LOT CITY TEL N07-
USE OF
BUILDINGS DISTRICT NO. G,.R.00DUP MAPF PG
co ' B
_ o y�G -� � /Y
AD44S eel•- � CONNECTION DATA
TEL. N /� STATION -�� DEPTH 9
/ STATE
r ❑ STATE 'MANHOLE REFERENCE OW
REGISTRATION NO QY ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTION LENGTH FROM q.�
HOUSE SEWER CONNECTING TO �Gr G�JR P L M L TO P L A
PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100 _
CONNECT ADDITIONAL BLDG OR, re)/ P C NO
WORK TO HOUSE SEWER 1.00 CO IMP NO Ire)
JOB NO.
ALTER OR REPAIR EKISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL-DRYW ELL
WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
$ t o0
PERMIT CONNECTION CHARGE FEE
OWNER'S
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
Pt
TRACTORIHAVE TTOS CONNECTDATE CONTRACTED HEABOVE DESCRIBED EXISTH THE NINGA ! ED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURC
TO THE PUBLIC SEW R
SIGNED THIS DAY OF ®� `� NEW HOUSE SEWER
OWNER OR f�. , CONNECT ADDITIONAL
OWNERS A N SLG✓ BUILDING OR WORK
I' v SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[3DRYWELL[IAND 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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELESNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA O$ THAT 1 AM THE LEGAI;_10 ER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED I;ES EN r L�R '�TY. BACKFILL IT SEPTIC TANKS❑
i SEEP. PIT [3S) CESSPOOLS❑
SIGN RE
oe
YV J.FOX.COUNTY ENG! EER VALIDATION R.A.WOOD, CHIEF FLBG. INSPECTOR
9 o a S OCT 17 4 ' 4.5 0 11
E.
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0307240005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER / SEPTIC: X BUILDINGADDREM
TR: 12504 LT: 7 EXIST OCC GRP: 6453 LIVIA AV
BLDGS. NOW ON LOT: TEMP CA 917801330
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: EMPEROR
5382-019-002 ORIGINATION: THOMAS PAGE: 596 GRID: H1 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
MANHOLE REFERENCE: UPPER/LOWER: S ON:
07/24/03 JK 01/20/04
COUNTY IMPROVEMENT NUMBER:
L. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
SHAW JOHN - JOB NUMBER:
6453 LIVIA AV TRUNK PERMIT NUMBER: Z�'D3
TEMP 917801330 ROAD PERMIT NUMBER: C
AFFADAVIT: NO REPAIR SEWER LINE
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
RESCUE ROOTER -
475 E ARROW HWY RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
AZUSA CA 91702 HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. N0: FEES PAID APPROVALS INSPECTOR SIGNATURE-
RESCUE
IGNA URRESCUE ROOTER (800) 269-6942-
475 E. ARROW HIGHWAY LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER
AZUSA CA 91702 744542 HIC * ,
01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDI IO A
15 ALT/REP HOUSE SEWER 1.00 EAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. IT(F-- TOTAL FEES 58.20
- SEPTIC TANK, SEEPAGEPIT
LIC. NO: „ AND/OR DRAIN FIELD
DRYWELL
SEWER MAP B00 r ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS _
SEEP. PIT CESSPOOL
GRAYWATER
* ADDITIONAL DATA ON FILE
REPORT ID: DPR266 ROUTE TO BS0508