HomeMy Public PortalAbout6466 LIVIA AVE_Sewer__ E-6D
S 6 68 3•SS
APPLICATION FOR PERMIT _
8 H-6
DMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN ceoss ST G�/N�/P m /2_�
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK
TRACT
ADDRESS
NO OF BLDCA.
SI OTNOW ON LOT /! CITY TEL. N0.
USE OF yIM
BUILDINGS �r�ps /� DISTRICT NO. GROUP �f� MAP
CONTR t 4 �u'�I�� •d N-'� _ +o /(Ip
ADDRE � -,� ��Eeer�j ,��yBei1/�!� - .,o/� CONNECTION DATA
L. NO. JAG STATION / �� DEPTH 4
[ISTATE MANHOLE REFERENCE S ®, QfAPER"
REGISTRATION NO. Z! 6/a ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO �t1 TYPE OF CONNECTION LENGTH FROM
�Y (� 4ties" ( P L. M L TO P L. 6J
PUBLIC SEWER Q $ 3 50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00CONN _
W ETO HOUSE SEWER CT ADDITIONAL BLDG OR 1 00 _CO. IMP NO „/StU P. N
ORK
JOB NO..
ALTER OR REPAIR EXISTING
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-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
1�
PERMIT CONNECTION CHARGE FEE
OWNER'S S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVE TRACTORiTOS DATE CONNECT THECTED WITH THE ABOVE DESCRIBED EXIST-LNG IED CON-
DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEYY
SIGNED THIS AY O e0 1f NEW HOUSE SEWER D../ - uU,
OWNER OR CONNECT ADDITIONAL
OWNERS GEN - BUILDING OR WORK
SEPTIC , SEP,
ADDRES /- - " f T / AND/ORT DANKRAINFEELDPIT(S)
'�
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL ElDRYWELL❑
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 GISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES/COU TY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR AT 1 AM THE LEGAL' W ER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED Z SI NT C P CKFILL SEPTIC TANKS❑
i
EEP. P1T(S) ❑ CESSPOOLS O
SIG
PER TEE
ILL J.FOX.COUNTY ENG1 ER VALIDATION t2.A.WOOD, CHIEF PLBG. INSPECTOR
�C0 9 0 8 7 OCT 17 4 4.5 0 in
--l—COUNTY-OF LOS ANGELES - TEMPLE CITY # 0508 - SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0510190004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 ERT.
LEGAL ID SEWER SEPTIC SEWER BUILDING ADDRESS
TR 12504 LT: 14 EXIST OCC GRP 6466 LIVIA AV
BLDGS. NOW ON LOT TEMP CA 917801329
ASSESSOR INFORMATION NUMBER CONNECTION TYPE NEAREST CROSS STREET ROSEMEAD
5382-018-002 ORIGINATION THOMAS PAGE: 596 GRID: H1 LOCALITY- TEMPLE CITY, C
LENGTH ML TO PL STATION: DEPTH
TENANT MANHOLE REFERENCE UPPER/LOWER ISSUED ON- PROCESSED BY EXPIRES ON:
10/19/05 JK 04/17/06
COUNTY IMPROVEMENT NUMBER
OWNER TEL NO PLAN CHECK NUMBER FINAL DATEe/�� �Y CODE
CHEN, PEARCE (626) 291-5774- JOB NUMBER
6466 LIVIA AV TRUNK PERMIT NUMBER _
TEMP 917801329 ROAD PERMIT NUMBER DESCRIPTION OF WORK
AFFADAVIT NO REPAIR 6 FT SECTION OF SEWER -
WAIVER- NO
APPLICANT TEL NO EASEMENT: NO
GALLARDO (800) 269-6942- _
475 E ARROW HWY RECORD INSTRUMENT NBR RECORD DATE SPECIAL CONDITIONS
AZUSA,CA 91702 HIGHWAY/STREET WIDENING
STATE ENCROACHMENT PERMIT NUMBER
CONTRACTOR TEL NO FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
RESCUE ROOTER (800) 269-6942-
475 E ARROW HIGHWAY LIC NO FEE DESCRIPTION: QUANTITY: UOM AMOUNT- NEW HOUSE SEWER
AZUSA CA 91702 744542 HIC
O1 PERMIT ISSUANCE FEE 27 75 CONNECT ADDITIONAL
15 ALT/REP 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: AND/OR DRAIN FIELD
DRYWELL
SEWER MAP BOOK PAGE. ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACYPILL SEPTIC TANKS -
SEEP PIT CESSPOOL.
GRAYWATER SYSTEM
i
* ADDITIONAL DATA ON FILE
REPORT ID DPR266 ROUTE TO BS0508