HomeMy Public PortalAbout9436 LAS TUNAS DR_Sewer__ /24650 INSERTS '
7EBoes_s0.
�eAsazo APPLICATION °I=OR �PERIVIIT
_ COUNTY OF LOS ANGELES SIEWER—SEWAGE DlSP®SAL- ,
DEPARTMENT OF COUNTY ENGINEER'
BUILDING AND SAFETY DIVISION - TADDRESS-
IWOHN
- .
.. ineer
LIAM AIENSENCSup!ofnBuilding FOR APPLICANT "TO FILLIN UL y.+ t /
. LEGAL
OWNER,
DESCRIPTION LOT NO.
�BLOCK - - - TRACT / MAIL f J�' ADDRESS ..
NO.OFBLDGS.
SIZE OF LOT NOW ON LOT 'CITY TEL -NO -
USE OE DISTRICT N0. GROUP MAP P CESSED BY
BUILDINGS _ � BK PG
CONTRACTOR
ADDRESS r y'iCLK -, CONNECTION DATA C�F
CIT �/ �. EL.N0, / STATION .. ::DEPTH.
TE MANHOLE REFERENCE( 1 UPPER
REGISTRATION N0. �5 COUTANTY NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ._./
PUBLIC SEWER _ @° $ •00 TYPE OFCVNTKqTION LENGTH FROM-
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
ITS AND/OR DRAINFIELD @ $::D0 _ ..
OVERFLOW SEEPAGE PIT, DRAINFIELD `
EXTN..CESSPOOL. DRYWELL @ •S .00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ S1 00 CO.IMP. NO. JOB OB NO. -�.
CONNECT ADDITIONAL BLDG.OR - TRUNK PERMIT NO. ROAD PERMIT NO. V
WORK TO HOUSE SEWER @ S .00
'ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT P4
SEWER OR DISPOSAL SYSTEM - 9, .00 ,PERMIT NO. - F
INDUSTRIAL
WASTE APPROVAL 'K z^""
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE - REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE,HEREIN_NAMED CON- _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING 'DWELLING APPROVALS DATE-r INSPECTOR'SSIGNATURE
TO THE PUBLIC.SEWER.
SIGNED THIS DAY OF 19;.• NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR.WORK
ADDRESS' -SEPTIC TANK,SEEP.PIT(S) -
- AND/OR DRAINFIELD
1 HEREBY.ACKNOWLEDGE,THAT-I HAVE--.READ.-THIS.APPLICATION - -. -• - -.
AND STATE-THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑... DRYWELL ❑ 1�
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING,AND SEWERS. SEWAGE DISPOSAL SYSTEM - -
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED,AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OFABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL 'OWNER --THE ABOVE .BACKFILL-SEPTIC TANKS ❑
SIGN'
DESCRIBED, RESIDE L P - TY. '
SIGNATURE SEEP.PIT(S)..❑ CESSPOOLS ❑
OF PERMITTE -
„
6F
ROBERT A., WOOD
VALIDATIO
CK. m.0.. cASR SUPERVISING MECHANICAL ENGINEER
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER ERM T
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508`0005170004„
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 =a=
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER / SEPTIC: S BUILDING ADDRESS:'
TR: 6561 LT: 739 EXIST OCC GRP: 9436-LAS UNAS7DR
BLDGS. NOW ON LOT: t1 TTEMV_:CA 917802135
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: OAK
8587-006-011 ORIGINATION: THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
05/17/00 UT 11/13/00
COUNTY IMPROVEMENT NUMBER: IZ
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
HERRMANN MANFRED;HELGA W JOB NUMBER:
9436 LAS TUNAS DR TRUNK PERMIT NUMBER:
TEMP 917802135 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO INSTALL 4" CAST IRON, 2-WAY CLEAN OUT TO GRADE
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
GOOD DAY PLUMBING, INC. (626) 285-8080-
9729 E. LIVE OAK RECORD INSTRUMENT NBR_ RECORD DATE: SPECIAL CONDITIONS:
TEMPLE CITY HIGHWAY/STREETSWIDENING: �,
STATE HM�E�N� P—ERM`'T�NUQM E
CONTRACTOR: TEL. NO: �REESa�\ APPROVALS DATE INSPECTOR SIGNATURE
GOOD DAY PLUMBING (626) 285-8080-
9729 E LIVE OAK LIC. NO FEE/DESGRI,P.TION:� QUANTIT\UOM: AMOUNT: NEW HOUSE SEWER
TEMPLE CITY CA 91780 565485 ��/ 7-
,,�y 01 PERM-IIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
/11,15 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. N0: / I 1111111 AND/OR DRAIN FIELD
1L DRYWELL _
SEWER MAP BOOK: PAGE: U pL (( 1)(�/� ALTER, REPAIR, SEWER OR
ju�u5luf��� SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
O' 0 ABANDON HOUSE SEWER
Al
O ❑ � 1t. BACKFILL SEPTIC TANKS
, i �`� SEEP. PIT _ CESSPOOL
GRAYWATER SYSTEM
Service0
C
REPORT ID: DPR266 ROUTE TO BS0508