HomeMy Public PortalAbout9521 OLIVE ST_Sewer__ t
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
• DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1301070005
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: ISEWER / SEPTIC: SEWER
1 BUILDING ADDRESS:
ON FILE IEXIST OCC GRP:
_IBLDGS. NOW ON LOT: TEMP CA 9117803132
ASSESSOR INFORMATION NUMBER: lCONNECTION TYPE:
18588-025-021 ORIGINATION: NEAREST CROSS STREET: CITY
I THOMAS PAGE: 596 GRID:D: J4 J4 LOCALITY: TEMPLE CITY CA[
I ILENGTH ML TO PL: STATION: DEPTH:
(
1 TENANT: IMANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: [
1 101/07/13 SR
I ICOUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: IPLAN CHECK NUMBER: IFINAL DATE FINAL Y: CODE:
1HROBLAK, JEREMY - IJOB NUMBER:
9521 OLIVE ST ITRUNK PERMIT NUMBER: l
TEMP 917803132 IRQAD PERMIT NUMBER: JDENCRIPTICRT OF WORK
IAFFADAVIT: NO IREPrACE SEWER CLEANOUT
(WAIVER: NO I I
(APPLICANT: TEL. NO: (EASEMENT: NO
DOBBINS, KEVIN (310) 838-0408- I 1
3801 LENAWEE AVENUE RECORD INSTRUMENT NBR: RECORD DATE: (SPECIAL CONDITIONS:
ICULVER CITY CA 90232 HIGHWAY/STREET WIDENING: I
STATE ENCROACHMENT PERMIT NUMBER:
I L I do&uyt uso+-t-%
(CONTRACTOR: TEL. NO: I FEES PAID IAPPRU ALS DATE INSPECTOR SIG TURE 1
IMIKE DIAMOND PLUMBING INC (310) 687-3258- 1 �_ 1
13801 LENAWEE AVE LIC. NO IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:INEW HOUSE SEWER v1
ICULVER CITY CA 399170 * , 1 1 I 1
1 101 PERMIT ISSUANCE FEE 27.80 ICONNF.CT ADDITIONAL 1 I
[ 115 ALT/REP HOUSE SEWER 1.00 EAC 30.50 IBUILDING OR WORK 1 I
1ARCHITECT OR ENGINEER: TEL. NO: [ TOTAL FEES 58.30 I_ I
I - [ ISEPTIC TANK, SEEPAGE PITI
1 LIC. NO: I IAND/OR DRAIN FIELD I 1
1DRYW3LL
I
1 SEWER MAP BOOK: PAGE: 1 [ALTER, REPAIR, SEWER OR I I I
I [SEWAGE DISPOSAL SYSTEM
[ 1 [DISCONNECT PLUG AND I I 1
I I [ABANDON HOUSE SEWER I I I
1 1BACKFILL SEPTIC TANKS -1 1 1
1 1 ISEEP PIT- CESSPOOL I
I 1GRAYWATER SYSTEM 1
I [ I [ I 1
1 I I I I
I* ADDITIONAL DATA ON FILE
[ [ I I
I I [ [ [ [
1 1REPORT ID: DPR266 ROUTE TO BS0508
24650 INSERTS'
i P
C'E606 6=60
76AS420 APPLICATION FOR PE
COUNTY OF LOS ANGELES SEINER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER _
BUILDING <--�'
BUILDING AND SAFETY DIVISION ADDREss ' � =
VJ1L� A. LAMBIE. County En neer
L1AM A. JENSEN, Supt of Building LOCALITY —
.NEAREST j
FOR APPLICANT TO FILL IN _CROSS ST. ' I
LEGAL �✓ �; -x - j;'
DESCRIPTION LOT N0. _OWNER
BLOCK TRACTMAIL
' f ( ADDRESS
NO.OF BL.DGS, c>
SIZE OF LOT NOW.ON LOT CITY TEL. NO..
USE OF s + IYISTRICT NO. GROUF MAP PROCESS9D BY
BUILDINGS - /^•^`� •_-"' '"�" -
BK PG si
CONTRACTOR
L.
ADDRESS `i �, �' r ,CONNECTION DATA
CITY TEL.N0, r N,y §i ' STATION DEPTH
= _:
STATERE
MANHOLE REFERENCE
REGISTRATION NO. f❑ COUNTY — I r 'LOWER
NO,. DESCRIPTION OF WORK FEE ,.-_---
HOUSE:E`'NER CONNECTING TO I _ _
PUBLIC SEWER �� $3.00 Y TYPE OF CONNECTION LENGTH FROM
SEPTIC TA 'K, SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS ANDi_O_R DRAINFIELD @ $3.00 _ -
OVERFi..OW SEEPAGE PIT,DRAINFIELD
F.XTN—CESSP001_. DRYWELL @ $2.00 —
HORSE SEWER CONNECTING TO r ? P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO, JOB NO.
CONNECT ADDITIONAL BLDG,OR OTRUNK PERM[T,NO.. ROAD PERMIT NO °�•:f _ 'f 1 Q
WORY.TO HOUSE SEWER @ $1.00 r �: < i V
ALTER. OR ABANDON HOUSE .STATE ENCROACHMENT
1 SEWER OP, DISPOSAL SYSTEM ° :$.1.00 PERMIT N0. Q
:INDUSTRIAL
WASTE APPROVAL. C+7
Ga
CHARGES
OWNERS PERMIT - $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE � REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19— NEW HOUSE SEWER
OWNER OR � CONNECT ADDITIONAL
OW4dcRSAGENT<� '�"'"""' BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP.PIT(S)
- AND/GR ORA[NFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _CESSPOOL ❑ DRYWELL Cl
WITH ALL COUNTY ORDINANCES AND .STATE LAWS REGULATING
ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSESAN
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE —
ER
.DESCRIBED RESIDEITI L PROPERTY. BACKFILL SEPTIC TANKS ❑ 9
SIGNATURE SEEP,PIT(S) ❑ CESSPOOLS
- ❑1
OF PERMITTEE i -
VALMATIO m ROBERT A. WOOD
CK. Y.0. CASA
SUPERVISING MECHANICAL. ENGINEER
�
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