HomeMy Public PortalAbout9056 RANCHO REAL RD_Sewer_6/7/2010_SE 0508 1006070001 COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1006070001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: (SEWER / SEPTIC: SEWER I BUILDING ADDRESS: 1
ITR: 11218 IT: 1 BL: D EXIST OCC GRP: 9056 RANCHO REAL RD 1
IBLDGS. NOW ON LOT: I TEMP CA 917803030 1
(ASSESSOR INFORMATION NUMBER: (CONNECTION TYPE: I NEAREST CROSS STREET: SULTANA I
15388-005-001 (ORIGINATION: I THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY, Cl
[ LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY:
106/07/10 SR I
I ICOUNTY IMPROVEMENT NUMBER:
10WNER: TEL. NO: IPLAN CHECK NUMBER: F ATE F CODE:
IWESTGATE, ROBERT (626) 230-4540- JOB NUMBER: I / ' 1
19056 RANCHO REAL RD (TRUNK PERMIT NUMBER: I I
ITEMP 917803030 IROAD PERMIT NUMBER: I SCR TI N OF W I
IAFFADAVIT: NO [SEWER CLEAN OUT 4 REPAIR 1
IWAIVER: NO I 1
1APPLICANT: TEL. NO: (EASEMENT: NO I I
IECONO AIR (800) 503-2666- 1 I I
19056 RANCHO REAL RD. IRECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS: [
ITEMPLE CITY CA 91780 [HIGHWAY/STREET WIDENING: 1 I
I (STATE ENCROACHMENT PERMIT NUMBER: 1 I
I
1CONTRACTOR: TEL. NO: FEES PAID 1APPROVALS DATE INSPECTOR SIGNATURE 1
IECONO AIR (800) 503-2666- I 1 1
14915 E HUNTER ST LIC. NO 11FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:INEW HOUSE SEWER 1 1
(ANAHEIM, CA 92807 445220 1 1 1 1
I 101 PERMIT ISSUANCE FEE 27.75 [CONNECT ADDITIONAL 1 I [
I 115 ALT/REP HOUSE SEWER 1.00 EAC 30.45 IBUILOING OR WORK 1 I [
1ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.20 1 1 I [
I ISEPTIC TANK, SEEPAGE PITT [ I
LIC. NO: I 1AND/OR DRAIN FIELD I 1
1 IDRYWELL
I
1 SEWER MAP BOOK: PAGE: 1 (ALTER, REPAIR, SEWER OR [ I
I I (SEWAGE DISPOSAL SYSTEM I 1 1
I 1 IDISOONNECT PLUG AND I I 1
1 I 1ABANDON HOUSE SEWER I [ [
1 I 1BACKFILL SEPTIC TANKS
ISEEP. PIT _ CESSPOOL
GRAYWATER SYSTEM
3 lA -i e Y
I I I I
s. 1
I I I
I (REPORT ID: DPR266 ROUTE TO BS0508 [ [ [
I I I I I
APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles rUILDING
115,
PDDRESS v"
JOHN A. LAMBIE, COUNTY ENGI-NEER
b, CAS-QATT D. GRIFFIN, SUPT OF BU(L-MNG
LOCALITY
FOR APPLICANT TO FILL IN NEARESr. ,T
LEGAL
DESCRIPTION LOI NO. 4 OWNER
BLOCK TRAMAILCT A D 7 D5R.C��S
N0. OF B L D G S.
SIZE OF NOW ON LOT CITY
USE OF
R U ILDiN GS DISTRICT NO GROUP MAP
BK P5,
CONTRACTOR
CONNECTION DATA
ADDRESS
STATION 7s DEPTH
CITY TEL. NO.
is ° MANHOLE REFERENCE FR
STATE X LOWER
REGISTRATION NO, / I, ', /, , , -T ',,-
7, COUNTY
NO. DFSCRI?TJ0N OF WORK
TYPE OFION LENGTH FROM
P�BE"C S,rWER,
V,L. TO P.L,
SEPTIC TANK,SEEPAGE PIT OR
PITS AN OR DR INFIELD- -D�l - - - - -- ----4,
OVERFLOV,I SEEPAGE PIT,DRAINFIELDC. NO,
�'7
4Th., E S P 0 0 L,DR Y WEL L,P!A N'H 0 L E S 2,00, 1 M,P,7r'0_ 7
HOUSE SEWER ccNN-'-cTING TO
j_P11 VAT E DISPOSAL �STEM Y S 1.00 -RUNK PERMIT 340. ROAD PERMFT P40'A
I CONNECT ADDIT101,iAL BLDG,OR STATE ENCROAC CHMENT
WORK•10HOUSESEW-E-R (q' _$_1`00- PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM (q'. $1.0 0
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
0NER'S P
w ERMI-T �ZEIMBURSEVIENT FEE
AUTHORIZATION I TOTAL FEE
-
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS 1.1 TEiNSPECTOR'S SIGNATURE
TRZ�CTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLiNG
TO THE PUBLIC SEXIER. NEW HOUSE SEWER
SIGNED THIS—)--DAY OF
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT—,�L„ L4.c.
'SEPTIC TANK,SEEP,PITS
2'
AODRESS=7� -4-1- --AND/OR DRA114FIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CO-RECT AND AGREE TO COMPLY CESSPOOL L) DRYWELLI--'
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING I
USI, ING AND SEWERS, SEWAGE.DISPOSAL SYSTEM
I HERESY CERTiFY THAT I AM PROPERLY REGISTERED AND''OR
LICENSE-, AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
DISCONNECT PLUG AND
C�ALIVORN!A OR THAT I AM THE OWNER OF ABANDON HOUSE, EVER
1HE ABOVE --------
DESCRIBED RESIDENTIAL, PROPERfY BACKFILL SEPTIC TANX:;
-3,
SIGNATURESEEP.PIT(S) LI CESSPOOL
OF PERMITTEE
OHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A, WOOD, C,4!EF lk.EIG. V,--cTQ R
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