HomeMy Public PortalAbout9416 LOWER AZUSA RD_Sewer__ DEPAI&TMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDINO
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS .y
FOR APPLICANT TO FILL IN LOCALITY
BUILDINGNEAREST
ADDRESS 9 f CROSS ST.
LOCALITY DISTRICT NO. SEVL NO. PERMIT NO.
NEAREST
A S
CROSS ST.
ECEIVED BY Ready for Inapeotion DATEISSUED
OWNERMAIL
ADDRESS ::& , USE ZONE OCCUPANCY B. AP
PQ_
CITY ELAO. -. D' -a�/ I � � I �—•, �Ca
CONTRACTOR
CO.IMP.N0.
ADDRESS JOB NO.
if
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION ® COUNTY ROAD.PERMIT N0.
LEGAL / STATE ENCROACHMENT
DESCRIPTION LOT NO..#�.Q PERMIT NO.
BLOCK TRACT 4W
WASTE APPROVAL _ ----
SIZE OF LOT F JC r*k/ NO.OF 1 J NOW ON LOTS // CHAR S
BUIILDINGS �%r�+ems CONNECTION CHARS FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER 04 $ 3.50 ,tj RECEIPT NO. DATE IBY
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTIO RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I O E I BY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC SEEPAE
PITS AND/OR TANK, OR 2,00
CESSPOOL—DRYWELL STATION DEPTH
7L- c�
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE -
7isc^Rr LOWER
TYPE OFCI)Rg ECTION L N T P.LOM ,
OWNERS PERMIT $ I 00
AUTHORIZATION TOTAL FEE �
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED,
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS--.-.—...DAY OF_.._.—....—... NEW HOUSESEWER Sc.Ayor,
OWNER OR - CONNECT ADDITIONAL
OWNERS AGENT._....._.._...__._..._._.._..._._..—.—. BUILDING OR WORK
EPTIC TANKSEEP.
ADDRESS..._.._.._..__ -- AND /OR DRAINFIELD IT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON NOOSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANK$
SIGNATURE _ � ��,�� SEEP.PIT(S)[] CESSPOOLS
OF PERMITTEE. _.......
7GA642A 663 7/53 /` r
S
} j COUNTY OF LOS ANGELES TEMPLE CITY # 0508 I SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS I SE 0508 0302070019
e BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
y PHONE: (626) 285-0488 EXT:
- LEGAL ID: SEPTIC: X BUILDING ADDRESS:
TR: 12998 LT: 1 BL: .001 EXIST OCC GRP: 9416 LOWER AZUSA RD
BLDGS. NOW ON LOT: TEMP CA 917804219
ASSESSOR INFORMATION -NU B CONNECTION TYPE: NEAREST CROSS STREET: TEMPLE CITY
8592-003-023 ORIGINATION: THOMAS PAGE: 596 GRID: J5 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
MANHOLE REFERENCE: UPPER/LOWER: ISSUED-ON: PROCESSED B : EXPIRES 0 :
COUNTY IMPROVEMENT NUMBER: 02/07/03 JK 08/06/03
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
BLAKEY NORMAN R;BELETHA J 0818) 444-0442- JOB NUMBER: yL Q--
9416 LOWER AZUSA RD TRUNK PERMIT NUMBER: + L-�!
TEMP 917804219 ROAD PERMIT NUMBER: DESCRIPTION O
AFFADAVIT: NO REPLACE SEWER LINE
WAIVER: NO
APPLICANT: TL. 0: EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR- RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET,.WI DEN.IW'C:'_",�.a
STATE ENCROACHMEN'7-P_ERM•IT.aNUMBER;••,
CONTRACTOR: TEL. 0: a / -Z�F_ES•PA'ID APPROVALS DATE INSPECTOR SIG AT RE
SAME AS OWNER
LIC. NO FEE.�DESCR'I•PTION: ;? QUANTITY': UOMt v, AMOUNT: NEW HOUSESEWER
01�PERMIT ISSUANCE FEE' -`�� 27.75 CONNECT ADDITIONAL
A15 15 ALT/PEPAHOUSE SEWERa 1.00 EAC `, 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER: L. 0: / f-- TOTAL FEES \ �� 58.20
Eui_u
` SEPT C N , S AGLIC. N0 �! J __J, 4 - - ,1 AND/OR DRAIN FIELD
- -• .i- i i l DRYWEL —
SEWER MAP BOOK: PAGE: i _
ALTER, REPAIR, SEWER OR' 7l
r SEWAGE DISPOSAL SYSTEM /
7--12--y3 T V
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS _
[I SEEP. PIT CESSPOOL
GRATWATER SYSTEM
REPORT ID: DPR266 ROUTE TO BS0508