HomeMy Public PortalAbout5137 MCCLINTOCK AVE_Sewer__ DEPAIiTAU24T OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 49 3 1
DIVISION OF BUILDING AND SAFETY 'PERMIT APPLICATION
COUNTY OF LOS ANGELES
UILDIN
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS 7 //"
FOR APPLICANT TO FILL IN LOCALITYBUILDIN
ADDRESS 5 137 McClintockt
CROSST
S .
LOCALITY Fl Monte DISTRICT NO. w SERIAL NO. PERMIT NO.NEAEST
c
CROSS ST. / le IS
A � �7
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER James $aberle
MAIL s� USE ZONE OCCUPANCY BK MAP PG
ADDRESS e
CITY TEL.NO. � ��s'
CONTRACTOryalifo nia Sewer Constoriga CO.IMP.N0, f
ADDRESS 1317 Colegrove Ave. JOs ,
CITY Montebello TELAdNion 1-5048 TRUNK P IT NO.
TATE
REGISTRATION NO]_04445 St9AUNTY ROAD PERMIT N .
LEGAL
DESCRIPTION LOT NO. • /� STATE ENCROACHME
PERMIT NO.
BLOCK TRACT/,R,.J °7-4 f` INDUSTRIAL `
WASTE APPROVAL
812E OF LOT' ' 06 1 k NOW ONO.OFN LOTS• C 8
USE OF Re
BUILDINGS CONNECTION CHARGE SEE
N0. DESCRIPTION OF WORK FEE
/ �°
REIMBURSEMENTAE
HOUSE SEWER CONNECTING TO
1 PUBLICSEWER a $ 8.50 a RECEIPT�tO. I DATE Y
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TNKSEEPAGE
PITS AND/OR�DRAINFIE DIT OR 2,00 �
CESSPOOL—DRYWELL STATION �7L�J✓O DEPTH
SPECIAL CONDITIONS ONLY 2.00 / MANHOLE REFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM /
OWNERS PERMIT s I 00 *.— XAM P.L. M.L.TO P.L. aur
AUTHORIZATION TOTAL FEE o
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE 'DATE
DWELLING TO THE PUBLIC SEWER aA
I
SIGNED THIS... DAY OF... r� / 19LNEWHOUSE SEWERi�OWNER OR -CONNECT ADDITIONAL
OWNERS AGENT.... BUILDING OR WORK
ADDRESS....... _ _ _. _. AND/OR DREPTIC AINFELDITIS)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPCESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGRTO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERDISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNABANDON HOUSE SEWER
AND STATE OF CALIFORNI OR THAT I AM THE LEGAL OWER OFTHE ABOVE ESC ED ESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)[3 CESSPOOLS
OF PERMITTEE._ ..1 .�. Sr
n...I.A eca Niro _' J�.M
1
• COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0405050001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL D: [EXIST
R SE T C: SEWER DING ADDR SS:
TR: 13384 LT: 22 BL: .001 OCC GRP: 5137 MCCLINTOCK AV
DGS. NOW ON LOT: TEMP CA 917803557
SES R I FO M TIO NUMBER: NNECTION TYPE: NEAREST CROSS STREET: FREER
8574-004-008 IGINATION: THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY
NGTH ML TO PL: STATION: DEPTH:
NA : NHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED EXPIRES ON:
05/05/04 VG 11/01/04
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAnL T FINAL BY: CODE:
VAN CLEVE, GREGORY (626) 454-2565- JOB NUMBER:
5137 MCCLINTOCK AVE TRUNK PERMIT NUMBER: 6
TEMPLE CITY CA 91780 ROAD PERMIT NUMBER: DESCRIPTIO'
AFFADAVIT: NO CONNECT ADDITIONAL WORK TO HOUSE SEWER
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER
01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
13 WORK TO HOUSE SEWER 1.00 EAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. N0: TOTAL FEES 58.20 v
SEPTIC TANK, SEEPAGE PIT
LIC. NO: AND/OR DRAIN FIELD
RYWELL -- '
SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS _
SEEP. PIT CESSPOOL
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO ; BS0508