HomeMy Public PortalAbout5615 NOEL DR_Sewer__ DEPARTMENT OF OOUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS exp 11� , np 11
FOR APPLICANMTOFI IN LOCALITY 71 c 1
BUILDING NEAREST _
ADDRESS CROSS ST�
LOCALITY DISTRICT NO SERIAL NO .rte PERMIT NO
NEAREST �1. ���1
CROSS ST ECEIVED BY Ready for loe0eefiea DATEISSUED
OWNER
MAIL
ADDRESS USE ZONE OCCUPANCY SK MAP PG
_ I
CITY TEL.N(L S
CONTRACTOR
ADDRESS
JOB NO
CITY TEL MO 6 TRUNK PERMIT NO
REGISTRATION NO�j�?��� 4�Z 8 COUNTY
ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT j/ WASTE APPROVAL
SIZE OF LOTS` 1 NOW ON LOTS, `�.. CHARGES
USE OF / CONNECTIO RGE FEE
BUILDINGS C'
NO D SCRIPiT1ON OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER as $50 Q RECEIPT NO ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00 NO
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT
N%OR DISPOSAL SAND YSTEM SEWER 100 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITSAND/ORDRAINFIELD 2A0 STATION �-} I DEPTHC�
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 200 11 PP REFERENCE _mtOw`
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TYPE OF CONNECT LENGTH FROM
IE
OWNERS PERMIT : 1 pp. ' M L TO P L � '
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTO SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS _��OF 19 NEW HOUSE SEWER IZ S
OWNEROR CONNECT ADDITIONAL
OWNERS AGENT z'?��_ _ _^ _ _ _ _ BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS _ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL 0
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS eALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT i AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABO DE8CRIBED RESIDWIAL ERTYBACKFILL8EPTICTANK �SIGNATURE SEEP PIT(S)0 CESSPOOLS
OF PERMITTEE _ _ _
78Ab42A 063 7/58
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COUNTY OF IAS ANGELES I TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1306260003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT
ILEGAL ID ISEWER / SEPTIC SEWER I BUILDING ADDRESS I
ITR 16116 LT 27 (EXIST OCC GRP I 5615 NOEL DR I
I IBLDGS NOW ON LOT I TEMP CA 917802320 I
(ASSESSOR INFORMATION NUMBER (CONNECTION TYPE I NEAREST CROSS STREET BROADWAY I
15387-025-008 �10RIGINATION
I THOMAS PAGE 596 GRID H3 LOCALITY TSMPEL CITY CAI
LENGTH ML TO PL STATION DEPTH
ITENANT IMANHOLE_REFERENCE UPPER/LOWER -(ISSUED ON PROCESSED BY 1
1 106/26/13 SR
I 11COUNTY IMPROVEMENT NUMBER I I
(OWNER TEL NO IPLAN CHECK NUMBER IFI F Y CODE
IRENNA STAN - IIJOB NUMBER I I
15615 NOEL DR 'ITRUNK PERMIT NUMBER
ITEMP 917802320 IROAD PERMIT NUMBER ID ."CRI ON F WORK I
1 1AFFADAVIT NO 11NSTALL A NEW CLEAN OUT I
IWAIVER NO
(APPLICANT TEL NO (EASEMENT NO I
IBRUCE SMYTHE (310) 286-8411- 1 I
13801 LENAWEE AVE IRECORD INSTRUMENT NBR RECORD DATE ISPECIAL CONDITIONS 1
CULVER CITY CA IHIGHWAY/STREET WIDENING I I
ISTATE ENCROACHMENT PERMIT NUMBER I I
I _
ICONTRACTOR TEL NO I FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE I
IMIKE DIAMOND PLUMBING (310) 838-0408- 1 1 1^ I
13801 LENAWEE AVE LIC NO IFEE DESCRIPTION QUANTITY UOM AMOUNT INEVI HOUSE SEWER �/)� I I
ICULVER CITY CA 90232 399170 1 1 1' C(/l�l 6 I I
I 101 PERMIT ISSUANCE FEE 27 80 1CONNECT ADDI ONAL I I I
I 115 ALT/REP HOUSE SEWER 1 00 EAC 30 50 IBU LDING OR WORK I I I
(ARCHITECT OR ENGINEER TEL NO I TOTAL FEES 58 30 1 1 I I I
I - I ISE�TIC TANK, SEEPAGE PITI I I
LIC NO i IANf/OR DRAIN FIELD I I
IDPiWELL I I I
I _1 _ I I �
SEWER MAP BOOK PAGE i IALIER REPAIR SEWER OR I I I
SEkAGE DISPOSAL SYSTEM
I I
I I IDISCONNECT PLUG AND
I I
I I 1AB.NDON HOUSE SEWER
I I I
I 1 IBACKFILL SEPTIC TANKS
ISEEP PIT _ CESSPOOL
I 1 IGRAYWATER SYSTEM I I I
I I I I I
I I I I I I
I 1 I I I
I I I I I I
1 _ IREPORT ID DPR266 ROUTE TO BS0508
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