HomeMy Public PortalAbout4943 MCCLINTOCK AVE_Sewer__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SE 0508 9612190002
` BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL
• IC: S G ADDRESS:
TR: 4902LT: 13 BL: E EXIST OCC GRP: 4943 MCCLINTOCK AV
BLDGS. NOW ON LOT: TEMP CA 917804104
ASSESSOR—INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET:
8574-024-018 ORIGINATION: THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISS 0 PROCESSED EXPIRES ON:
12/19/96 TC 12/19/97
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY•
YASSA JOSEPH G•VICTORIA M (818) 350-1136- JOB NUMBER: Q
4943 MCCLINTOCK AV TRUNK PERMIT NUMBER: 'Z��� p
TEMP 917804104 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO �tl SEWER FOR NEW ADDITION BATHROOM AND LAUNDRY ROOM
WAIVER: NO
APPLICANT: TE 0: EASEMENT: NO `�� �1
SAME AS OWNER - �b 'RECORD--D 7TE- � SPECIAL CONDITIONS:
RECORD INSTRUMENT�NBRHIGHWAY/STREET L-I'DENI'NG:'�STATE ENCROACHNEWT.. PERMIT.NUMBER: ��
CONTRACTOR: TEL. NO: FEES. AID ti APPROVALS DATE INSPECTYR SIGNATURE
SAME AS OWNER - `'�,if/� _ 'y r'
LIC. NO FEE DESCRIPTI'ON�e , --- OUANT'ITY�: UOM���� AMOUNT ' OUSE SEWER ,L
15 PERMIT ALT/REPIHOUSE EIdER y-i it;i'14100'iEAC! � j 30.-0 I BUILDINGAORIWORKAL
ARCHITECT 0 G 0: j'—•__Y.yll '--I'TOTAL WEST 4 9 I (U 58':05 I
LIC. NO: I r' i' i I i i ;J ;AND/OR DRAIN FIELD
SEPTIC TANK, SEEPAGE PIT
11---:� I/ • R W L _
SEWER MAP BOOK: PAGE: ` { r / TER,
,�'� •�� -�', "� �� REPAIR, SEWER OR
�eg.7 �.\ ��� t.j-s• �! SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS
SEEP. PIT _ CESSPOOL
u
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO SS0508
:E808 14-6:3
6 A.642U APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING rr ¢
ADDRESS
_-�
JOHN A. LANIBIE, County Engineer rye-- ---
VILLIAM A. JENSEN. Sup't of Building " ✓ s i � `
LOC AL.ITT' -----
NEAREST x
FOR APPLICANT TO FILL IN CROSS 5T
7 7f _ - 'F _— ...r� -. ,✓,CY dam.
DESCRIPTION LOT NO/1..i# $i .' OWNS R, 2i+r'
y.p�/ MAIL,
BLOCK �` TnACT "�"v- X'•'�.-. ADDRESS
- 110. OF BLOGS. -
.r`
SIZE OF i_OT ���% g NOW ON LOT CITY TEL. NO.
USE OF
�Y DISTRICTNO. GRCUPMAP PROCESSED BY
BUILDING - - BK PG _
CO
NTRACTOR%x
r
ADDRESS'^y> 1 A - F: _ CCl'NNECTION,DATA
_
STATION J_M _ DEPTH
CITY 'Y
J STATE MANHOLE REFERENCE. ,r .•?+
REGISTRATION NO. ,� ✓- ,;;'. '' s. ❑ COUNTY'. iy ;� $ LOWER
NO. 1 DESCRIPTION OF VVORK FEE: _ -�TYPE OF CONNECTION --- ALENGTH PROA
HOUSE SEVER GCNN£CTING TO r' _ v, CURB `P M.L. O P.L. , `s
-+p PUBLIC SE'✓v'ER 0 $5.00 I d+' l ,� _ P.C.NO. -- '
-_
SEPTICTANK.SEEPAGE PIT OR JOB NO,
PITSA.:lD !�R QR.AIN I LD CO.IMP. NO. -
_ _ _
---HOUSE SEW.P•_Oh NFtCTING TO--
TRUNK PERMIT NO. ROAD PERMIT NO. �
PRIVATE SP]>AL SYSTEM
_--
0 N'N ECT ADDIT+ON A�A�DG OR AFFIDAVIT WPIYEA! €ASE%€NT RECORD. INSTP..NU. DATE
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT.DRA NFIEL_U
_- EXTN.,CESSPOOL.DRYWEL L,MAN2 OL.E @ $5 00
_ — _ HWY.OR ST.WIDENING
1
ALTER,REPAIR OR ABANDON HOUSE
WFR ORi5PbSAl SYSTEM
__. STA'T'E ENCROACHMENT'
j PERMIT NO.
— - - ------
INDUSTRIAL
WASTE APPROVAL
_--_ CHARGES
LAh
WNERS PERMIT --
+L --
FEE
HORIZATION TOTAL FEE '�' CONNECTION CHARGE
< rr�'
VE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
CTc:.R TO HE ABOVE DESCRIBED EXISTING DWELLING"�. COYPdF':7 TTHE PU BL.IC SLWE� c. APrROYAL7 ! DATE I1P'15PECTQ6i,a.�.IG PJATJRE
NED THIS � DAY O,F �LR ORceNEW HOUSESEWERERSA.GENT ry .. s�- -._ .x_--ftr...` _ —__—--- CONItlECT ADDi TIONAL
BUILDING OR WORK
RF SS-- SEPT{r TANK,SEEP,PIT iSDHF;R E.BY Av;KNOWLEDE T'NAT I HAVE READ THIS APPLICA'T'ION qND/OR 4RAINFiELD STATE. THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYH A.LL COI NTY ORDINANCES AND STATE LAWS REGULATINGrryy'MBI NAG AND EWERS: CESSPOOL LJ DRYWF.-LLHEREBYCERTIFY THAT IAM PROPERLY REGISTERED AND%OR RL7EREPAIR.SEWER ORNSED AS REQUIRED AY L.OS ANGLES COUNTY AND STATE OFSEWAGt,DISP05AS.5YST'EMIf ORNfA 1?R THAI �.+ THE.LEGAL bWNER OF @ND IN'iEND 70 ISCONNECT PLUG AND
BFD RESIDENTIAL p'RG ERTY ABAtdbUN HOUSE SEWER
1LE IN. THE A@C„V'E,/ ESCFZY NATURE PER Ni1TTE ` '� ll°,� d J BACKFILL SEPTI TANKS []
Et/'-+s..; ty!",4--' ;G. .k.,e` _°,.:., ,r._---___, SEEF.PI ( ) L] CESSPOOLS ❑I
VALIDATION_ ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
%K.. M.O. '.rCASH.