HomeMy Public PortalAbout6219 OAK AVE_Sewer__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BE 0508 0908110001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: ISEWER / SEPTIC: SEWER BUILDING ADDRESS: I
1 ON FILE (EXIST OCC GRP: 6219 OAK AV [
1BLDGS. NOW ON LOT: TEMP CA 917801656 1
(ASSESSOR INFORMATION NUMBER: (CONNECTION TYPE: I NEAREST CROSS STREET:
15385-001-021 (ORIGINATION: I THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY, Cl
I ILENGTH ML TO PL: STATION: DEPTH: I 1
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
1 108/11/09 SR 08/11/10 1
ICOUNTY IMPROVEMENT NUMBER: 1
OWNER: TEL. NO: IPLAN CHECK NUMBER: 1FINAL DATE 7T� FINAL BY: CODE:
ICEN KWANG GE (626) 442-2571- [JOB NUMBER:
16219 OAK AV ITRUNK PERMIT NUMBER:
ITEMP 917801656 IROAD PERMIT NUMBER: IDESCRIPTION OF WORK I
IAFFADAVIT: NO 1CONNECT NEW 2ND: UNIT TO IC SEWER 1
(WAIVER: NO
I I
1APPLICANT: TEL. NO: (EASEMENT: NO 1 I
IQIU (626) 260-4600- 1 I I
1428 PARK AVENUE IRECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS:
IMONTEREY PARK 91754 (HIGHWAY/STREET WIDENING:
1 1STATE ENCROACHMENT PERMIT NUMBER: L I
(CONTRACTOR: TEL. NO: FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE
1 [
IGE, CEN KWANG (626) 278-7475- 1
16219 OAK AVENUE LIC. NO IFEE DESCRIPTION: QUANTITY: DOM: AMOUNT:INEW HOUSE SEWER
ITEMPLE CITY, CA 91780 NONE I I I I
101 PERMIT ISSUANCE FEE 27.75 ICONNECT ADDITIONAL 1
I 103 CONN TO PUBLIC SEWER 1.00 CON 46.95 IBUILDING OR WORK 1 I [
1ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 74.70 1 I I I
- I ISEPTIC TANK, SEEPAGE PITI I I
LIC. NO: I (AND/OR DRAIN FIELD i I I
I I 1DRYWELL _ 1
SEWER MAP BOOK: PAGE: 1 1ALTER, REPAIR, SEWER OR I I I
[ ISEWAGE DISPOSAL SYSTEM I I I
I 1 IDISCONNECT PLUG AND I I I
I I 1ABANDON HOUSE SEWER I I I
I I 1BACKFILL SEPTIC TANKS _I 1
[ ISEEP. PIT _ CESSPOOL _[
I 1 1GRAYWATER SYSTEM I I
I I I
I I I I I I
I I I I I I
I I I I 1 I
1 I I I I I
1 I I I I I
I 1 I I
I 1 1 I 1
IREPORT ID: DPR266 ROUTE TO ES0508
I I I I I
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
r
FOR APPLIGA TO ILL 11 LOCALITY
BUILDING ? i° (' NEAREST
ADDRESS ' ,2 4� CROSS ST.
LOCALITY _ DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST ( A $
CROSS ST. kj Fr
OWNER
! RECEIVED BY ( Ready for Inspection DATE ISSUED
MAIL
�'�-I 9
ADDRESS / �y USE ZONE OCCUPANCY MAP
SK PG
CITY TEL.NO.
CONTRACTOR
r d ' CO.IMP.NO.
ADDRESS JOB.N0. --
CITY
TEL.
NO` TRUNK PERMIT N0.STATE
—
REGISTRATION NO y
--- S,
COUNTY PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT -
-- PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT. �,JJ `, NO.OF SLOGS. j
9 `J 'L NOW ON LOT /v CHARGES
USE OF
BUILDINGS CONNECTJON CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.30 ( RECEIPT NO, DATE I BY
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 ND` I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEP71C TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 I STATION DEPTH
OESSPOOL—DRYWELL ff
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE;:FERENCE
UPPER' cn^
'TYPE OF C-OMMECTION LENGTH FROM
CURB - M.L.TO P.L.
OWNERSPERMIT $ ; 1 00
AUTHORIZATION I 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 THl&/. _.._._ F_. > _(4s'1 NEW HOUSE SEWER
OWNER QR CONNECT ADDITIONAL
�.. "� ,,p`-,� BUILDING OR WORK
OWNERS AGENT '_ ::ti•... ......
? SEPTIC TANK,SEEP.PIT(S)
ADDRESS �. f. ._ �,, ? ' :.... .............. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL 0 DRYWELL E]
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
AND/OR LICENSED AS REQUIRED BY DISCONNECT PLUG AND LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOV j)ESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)C] CESSPOOLS
SIGNATURE
OF PERMITTEE'.._ ...._
76A612D 663 I/53