HomeMy Public PortalAbout6436 LOMA AVE_Sewer__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0203250001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626). 285-0488 EXT:
LEGALI -
SEWER SEPTIC: Y BUILDING ADDR_ S: . .
TR: 14396 LT: $6 / EXIST OCC GRP: i 6436 LOMA.AV
BLDGS. NOW ON LOT: TEMP CA 91780.1333
ASSESSOR INFORMATION NUMBER:' ;:, , ;' CONNECT--ION TYPE: -NEAREST CROSS STREET: EMPEROR
5382-016-016ORIGINATION: THOMAS. PAGE:, 596 ' GRID:.H1 LOCALITY:'TEMPLE CITY
LENGTH ML TO PL: _ STATION: DEPTH: ,.
TE T. MANHOLE REFERENCE: UPPER/LOWER: ISSUEDON: PROCESSED B EXPIRES ON:
03/25/02 JK 09/21/02
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
JOHNSTON ROBERT J;KAREN M (626) 286-1560- JOB NUMBER:
6436 LOMA AV TRUNK PERMIT NUMBER:
TEMP 917801333 ROAD PERMIT NUMBER: DEISSURIPTION OF WURK C/
AFFADAVIT: NO REPLACE SEWER LINE
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET WIDEN-ING:
STATE ENCROACHMENT�PERMI_NUMBER;:
%// _. �0
CONTRACTOR: TEL. NO: FEES:PA� APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER i
LIC. NO FEE DESCRIPTION: yf QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER
01 FERMI?ISSUANCE FEE 27.75 CONNECT ADDITIONAL
03 CONN TO'PUBLIC-SEWER 1.00 CON 46.95 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. N0: TOTAL FEES� 71.70
SEPTIC TANK, SEEPAGE PIT
LIC. NO: 1111111 1 AND/OR DRAIN FIELD
DRYWELL _
SEWER MAP BOOK: PAGE: -
L-02 ALTER, REPAIR, SEWER OR
N 90 ��� ��I' ��� �� SEWAGE DISPOSAL SYSTEM.
- DISCONNECT PLUG AND
D G - ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS
- SEEP. PIT _ CESSPOOL _
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO : BS0508 .
i
D
S&E-663 12.54 APPLICATION FOR PERMIT 1
S Q E•6
DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer /
County of Los Angeles pODRess �(�' _ - 3`y✓¢ ��
WM.J. FOX. COUNTY ENGINEER
I CASSATT D. GRIFFIN,SUPT OF BUILDING
LOCALITY .✓`�i �,� �,e
n ,
FOR APPLICANT TO FILL IN CROSS T.
LEGAL '7I
DESCRIPTION LOT N0.
BLOCK TRACT I I/�� I MAIL
..�� ADDRES V '�I,LL_
NO. OF BLOGS. _
SIZE OF LOT NOW ON LOT -.LST _� ,i TEL. NO.
USE OF
BUILDINGS i,,..., 1 �=���� DISTRICTS O. ROUP MAP
1
I I BK PG
CONTRACTOR
ADDRESS,-1 _; % `' �/,' +- ^ ! /�.. CONNECTION DATA
J f
STATIONDEPTH
70 ,
M rA�-6TATE MANHOLE REFERENCE
REGISTRATION N0. If ❑ COUNTY �R� LOWER
TYPE OF CONNECTIP.L LENGTH FROM
No. DESCRIPTION OF WORK FEE Y. CURB M.L.TO P.L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. j CI JOB. NO.
WORK TO HOUSE SEWER 1.00
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
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE L_ �� REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH T HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCR ED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19 NEW HOUSE SEWER 12-l$
OWNER OR CONNECT ADDITIONAL
OWNERS AGEry,T BUILDING OR WORK
SEPTIC TANK, SEEP,PIT(S)
ADDRE AND/OR DRAINFIELD
i
I HE BY CtNOWLED THAT 1 HAVE READ THIS APP ON CESSPOOL❑ DRYWELL[IAND STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO LY
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 REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONN HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P PERTY. BACKFILL SEPTIC TANKS❑ �'" - -fT
SEEP. PIT(S) ❑ CESSPOOLS
SIGNATURE I
OF PERMITTE22 ;�.
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION
BY too BY 9 2 Tr, JUL 4 4.5 0,
DEPUTY DEPUTY
BY BY
T) DEPUTY �YLI. DEPUTY