HomeMy Public PortalAbout6028 PRIMROSE AVE_Sewer__ Y r
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COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
• DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0203060004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
' PHONE: (626) 285-0488 EXT:
LGAL • ER / SPTC: BUILDING ADDRESS:
TR: 6561LT: 259 EXIST OCC GRP: 6028 PRIMROSE AV
SLOGS. NOW ON LOT: TEMP CA 917802033
ASSESSOR INFO I N NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: GARIBALDI
5385-013-017 ORIGINATION: THOMAS PAGE: 596 GRID: J2 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LONER: ISSUED ON: PROCESSED BY: EXPIRES ON:
03/06/02 JK 09/02/02
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. 0: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
KONG, SHERMIN (616) 287-8003- JOB NUMBER:
6028 PRIMROSE TRUNK PERMIT NUMBER:
TEMPLE CITY CS 91780 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO CONNECT NEW SFR TO SEWER
WAIVER: NO
APPLICANT: TE 0: EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NB RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET YT -HdG-
STATE ENCRo�cHMEI(T'RE[ -1 L AA B R•
CONTRACTOR: TEL. NO: FEE �,p, APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER ��►
LIC. NO FEESDSCRI j6N• ' QUANTITY: AMOUNT: 0 SEWER
D
01PER S. CE F27.75 CONNECT ADDITIONAL
000 N TO US
_C_SEJ CON (.6.95 BUILDING OR WORK
ARCHITECT 0 ENGINEER: E 1p L FEES 7 .70
ZHANG, DAVID (626) 289-6300- SEPTIC AN , SEEPAGE I
301 N. ROSEMONT BLVD LIC. NO: 1111111 AND/OR DRAIN FIELD
SAN GABRIEL CA 91775 46379 ] -
DRYWELL
SEWER MAP BOOK: PAGE: p O UC
��1 O n P/,7 ALTER, REPAIR, SEWER OR
p) U �I w u� SEWAGE DISPOSAL SYSTEM
DISCONNECTPLUG AND
O p i I ABANDON HOUSE SEWER
❑ ", '' BACKFILL SEPTrC_7A_ffiCS_
��i
I�
SEEP. PIT _ CESSPOOL _
A El a��y GRAYWAT5RSSE
�O
46��c serve That �
REPORT ID: DPR266 ROUTE TO BS0508
i
=E808 3-42. APPLICATION FOR PERMIT `r`j
� � (
76A642D
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOS '
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS q y
JOHN A. LAMBIE. COUNTY ENGINEER
COLEMAN W. JENKINS, SUPT. OF BUILDING r�
LOCALITY
NEAREST 'wt •J T_ _-_. ___
FOR APPLICANT TO FILL IN, CROSS ST.
LEGAL-------- OWNER _
-DESCRIPTION LOT N9. /( v �� - --
- MAIL
BLOCK TRACT ADDRESS
NO. OF BLDG5 A�.., NOW ON LOT CITY TEL. NO. �
SIZE OF LOT �]y�--��-___ _
USE OF -�� r`R✓ -��'- DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS " -- _ BK PG
CONTRACTOR P _ _ ��f'C�V f' '/'��
—— 40-
` CONNECTION DATA
ADDRESS
STATION ( / DEPTH �
CITYNO-,-4.
UPPER
STATE LIC r MANHOLE REFERENCE - ,)el Y,�i y p
LICENSE_ NO, GL A55 _ `_- C-t 0
___.- t
LIE
NO. r .DES RIPTION OF WORK FEE TYPE OF TION M.L.IGT.
HOUSE SEWER CONNECTING TO - Y. --x CURB P.L. M. TO P.L.
,PUBLIC SEWER 55.00 1 P.C.NO.
SEPTIC TANK.SEEPAGE PIT OR CO.IMP.NO. / �' / .108 NO. _ )
PITS AND/OR DRAINFIELD _- $10.00 _ ------- -
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. 3 O
PRIVATE DISPOSAL SYSTEM $3.00 _-__ _ --
CONNECT ADDITIONAL BLDG.OR -- AFFIDAVIT WUVER i EASEM[Ni RECORD.INS7R.NO. GATE
WORK TO HOUSE SEWER _ $3.00
_i OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL.DRYWELL,MANH OLE $5.00 ') _ HWY.OR ST.WIDENING
I ALTER,REPAIR OR ABANDON HOUSE j -
SEWER OR DISPOSAL.SYSTEM @ $3.00T_ I STATE ENCROACHMENT
i PERMIT NO__-_, _
INDUSTRIAL
�- WASTE APPROVAL
CHARGES _.
OWNER'S PERMIT_ $! 21 oo - ----
-- -- CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE _ — --
REIMBUSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- -
R
TRACTOR TO CONNECT THE ABOVE DESCJRIBED EXISTING DW ELLiNG - APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEW'R. --
SIGNED THIS DAY OF `' I
'j f i7NEW HOUSE SEWER
OWNER OR
OWNERS AGE NI _ _. CONNECT ADDITIONAL
/ BVILDING OR WORK
ADDRESS
SEPTIC TANK,,SEEP,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE 70 COMPLY -- - ------
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL ❑ DRYWELL ❑ _
PLUMBING AND SEWERS.
LOS
- ----------
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR.
L.ICENSEO AS REOU.I RED BY ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBED.IRESIDENTIAL PROPERTY. ABANDON HOUSE SEWER J_
SIGNATURE j '�V BACKFILL SEPTIC TANKS ❑
OF PERMITTEE " ----- -' SEEP,PIT(S) ❑ CESSPOOLS ❑I
VALIDATION- JACK R. ALLEN
t' SUPERVISING MECHANICAL ENGINEER
CK. M.O. ( CASI"I l