HomeMy Public PortalAbout9100 RANCHO REAL RD_Sewer_4/11/2007_SE 0508 0704110001 COUNTY OF LAS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BE 0508 0704110001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: (SEWER / SEPTIC: SEWER BUILDING ADDRESS:
JTR: 11218 LT: 6 BL: D EXIST OCC GRP: 9100 RANCHO REAL RD
JBLDGS. NOW ON IAT: I TEMP CA 917803032
ASSESSOR INFORMATION NUMBER: lCONNECTION TYPE: NEAREST CROSS STREET: ROSEMEAD
5388-005-006 ORIGINATION: THOMAS PAGE: 596 GRID: H4 LOCALITY: TEMPLE CITY, Cl
LENGTH ML TO PL: STATION: DEPTH:
TENANT: (MANHOLE REFERENCE: UPPER/LOWER: ]ISSUED ON: PROCESSED BY: EXPIRES ON:
04/11/07 JK 10/08/07
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: JpLAN CHECK NUMBER: F TE FI CODE:
IMACCHIA MICHELE;ANTONETTA (626) 286-5770- IJOB NUMBER:
9100 RANCHO REAL RD TRUNK PERMIT NUMBER:
TEMP 917803032 IROAD PERMIT NUMBER: ID2SCRIPTION OF WORK
JAFFADAVIT: NO CONNECT GUEST HOUSE TO PUBLIC SEWER
WAIVER: NO
(APPLICANT: TEL. NO: JEASEMENT: NO
ITORRES (323) 447-1390- 1
RECORD INSTRUMENT NBP: RECORD DATE: ISPECIAL CONDITIONS:
(HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO: FEES PAID JAPPROVALS DATE INSPECTOR SIGNATURE
IMACCHIA, MICHELLE (626) 286-5770- 1
9100 RANCHO REAL ROAD LIC. NO IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:JNEW HOUSE SEWER
TEMPLE CITY, CA 91780 NONE
101 PERMIT ISSUANCE FEE 27.75 ICONNECT ADDITIONAL
103 CONN TO PUBLIC SEWER 1.00 CON 46.95 BUILDING OR WORK
(ARCHITECT OR ENGINEER: TEL. NO: TOTAL FEES 74.70
_ I SEPTIC TANK, SEEPAGE PIT
LIC. NO: AND/OR DRAIN FIELD
IDRYWELL _
SEWER MAP BOOK: PAGE:
ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
JEACKFILL SEPTIC TANKS _�
SEEP. PIT _ CESSPOOL _�
IGRAYWATER SYSTEM
(REPORT ID: 33PR266 ROUTE TO BS0508
_ � .r ®®pp .: g }gyp per -
6A PiA2D:-GEB0..8_f0=71 APPOE-ATIO FO.� PER.0� UT
COUNTY OF.LOS.ANGELES $E_' tR— 'E, V14'CIe•'Dll,Sp® �
DEPARTMENT OF COUNTY EN':GINEE:R
BUILDING AND SAFETY b1.V_ ISI — BUILDING
ADDRESS :l��O IC �+^
LOCALITY _
FOR APPLICANT`TO FILL IN: - GROSS BT:
LEGAL
DESCRIPYION LOT NO: OWNET;
• MAIL -
T:RACT' A-DORESS' 2�,� �'
-BLO.G IC .� _ ..
NO. OF SLOGS.
'SIZE OF LOT -_ '._ .NOW ON LOT` 'C'I'CY E}.. IVC,.,_rw
-
.B111LD'INGS 'D:I'S7RIC'TNG. �G,ROUP '• � MAP -
BK P+
60 NTR.4CTOR. r '
ADORessJ - ,. ;_ d _ C�.JOR_iNEC_ TION DATA
_
.CITY '- TEL. fm:_ DEPTH.. �5
SPATE LIC:
LICENSE. NO. - - CLASS .NNOL - C - — _ _ _
h(q �� E REFEREN'E, ��.�
No. DESCRIPTION OF WORK FEE TYPE, LENGT��O _
_ _ _ �.� � � _LOWER
.. .. .. OF - ION
P.USL'IC§EHOUSERRGONNECTING TO .�. $7:00 Q� y" CU P.L.. M.L.TO�P.L., -
-- :SEPTIC TA'N K,SEEPAGE PIT OR'. - - - P.C.NO.
.
... PITS.AND/OR CRAINFIEL'D ,� 510,00 CO,-1'Ii1P.NO. . JOB NO.
HDUSE','SEWER C'ONNECT]N.O TO TRUNK PERMIT NO. ROAD.PERMIT NO.. D.
PRIVATE.DISPOSAL 9.YSTE.M @ 5.8.00 -
�77 0.
CONNECT ADDITIONAL:SLOG.OR AFFIDAVIT` WAiYEa; manhTENT RECORD..TR"-r NO.J. DATE (�
WORK.TO HOUSE SEWER �� 5'S,OO: - '-
.OVERFLOW SEEPAGE.PIT.DRAINFIEI,.D � OC
EXTO-CES6POOL,DRYIUELL.
ALTER.-REPAIR OR ABANDON HOUSE Fi1H'y'.OR:'ST;WIDE_PI I'NG I.,..
SEWER OR'DfSPOSAC SYSTEM 53.00. .. - W--%TE.ENCROACH'ME_NT - W
MANHOLE NO. CL
' ..PERMIT _.
-- - - V:t+IDUs.TR.IAL
:WaTSE APPIROVAL Z
- PE "- - CHARGES
OWNER'S; BMTP . _ - � �. oo. - -
CONNECTION CKARGE'.FEE.
AUTHORIZATION I TOTAL FEE, !)
I..HAVE AT THIS DATE •A.CONTRACT WITH THE.HEROIN NAMED CON'- REIMBURSEMENT.FEX _
TRACTOR TO. CONNECT THE ABOVE"DESCRI BEDEXISTING.DWELLING -
TO THE PUBLIC
. F` A-nPROtlA4s DATE INS PEC-TOR.'s SIO-NAT-
URE
SIGNED:TFI ,ADAY O
f
OWNER:OR { NEW'H'OU$E SEWER
OWNMRS'AGENT CONNECT ADDITIONAL
ADORES BUILDING OR'WORK
S: -
SEPTIC�; :DRAT 6EEP,Orris)
I HEREBY ACKNOWLEDGE. THAT .1. HAVE' VE READ THISTHISAPPLICATIONAPPLICATIONli(D'/:OR�DRA'I�NFJ.EL'D
ANP STATE THAT THE ABOVE IS CORRECT A.ND AGREE.'f0 COMPLY
WiTH &I.L. iZiPUNTT ORDINANEES :AND STATE LA.Ws REGULATI-MG -
PL4MBING AND'S.EWERS, 'C6680.001. 'D ORYWELL Cl
I •HEREBY' CERTIFY THAT 1 :AM 'PROPERLY REGISTERED. A'ND/OR ALTER;REPAIR:SEWER OR _
LICENSED AS RE0L71RgD BY LOS ANGLES COUNTY',AND STATE Crt' SEW41GE::DISPdS L.SYSTEM
-CALj:F.ORNI_A OR THAT'I AM THE:L$GA'L.OWNER•OF',AND INTEN�TO DIS.GONNECT PLUG AND
RFS
ABOVE 1'N, 'THE ABOVE DESCRIBED RESIPMT:IAL PROPERTy.
ABANDON HOUSE SEWER
S'IGN'ATURE
OF PERMITTEE 5!(,( 1(FILL SEPO'TANKS [3 ,
BSC
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• - ♦�ALMAIOdY /%K.. M.O. '.CASH. -. .. .