HomeMy Public PortalAbout4835 ROBINHOOD AVE_Sewer__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0801290003
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: IISEWER / SEPTIC: SEWER I BUILDING ADDRESS: 1
ITR: 19043 IT: 28 IIEXIST OCC GRP: 1 4835 ROBINHOOD AV
JpLDGS. NOW ON LOT: I TEMP CA 917804029
(ASSESSOR INFORMATION NUMBER: (CONNECTION TYPE: I NEAREST CROSS STREET: 1
18585-009-010 [ORIGINATION: I THOMAS PAGE: 597 GRID: B5 LOCALITY: TEMPLE CITY, Cl
I ILENGTH ML TO PL: STATION: DEPTH:
(TENANT: IMANHOLE REFERENCE: UPPER/LOWER: [ISSUED ON: PROCESSED BY: EXPIRES ON: 1
JAMES BARNHART 1 101/29/08 SR 07/27/08
1 (COUNTY IMPROVEMENT NUMBER:
(OWNER: TEL. NO: [PLAN CHECK NUMBER: IFINAL DATE FI BY: CODE: [
1JAMES BARNAHRT (626) 575-7439- [JOB NUMBER: [ [
14835 ROBINHOOD AV ITRUNK PERMIT NUMBER: 1
ITEMP 917804029 ]ROAD PERMIT NUMBER: ID SCRIPTION OF WORK I
[ AFFADAVIT: NO ICLEPN OUT O SEWER LATERAL & OPEN TRENCH [
[ WAIVER: NO 1
[APPLICANT: TEL. NO: IEASEMENT: NO ] [
(BRUCE SMITH (310) 838-0408- 1
9
3801 LEWAEE AVE IRECORD INSTRUMENT NBR: RECORD DATE: ISPEdIAL CONDITIONS:
ICULVER CITY I `HIGHWAYSTREET WIDENING: I Y((STATE ENCROACHMENT PERMIT NUMBER:
I
ICONTRACTOR: TEL. NO: I FEES PAID IAPPROVALS' DATE INSPECTOR SIGNATURE
IGEORGE BRAZIL PLUMBING (310) 838-0408-
13801 LENAWEE AVE LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER I I I
ICULVER CITY, CA 90232 614102036 * I I I
I 01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL ,I I
I 115 ALT/REP HOUSE SEWER 1.00 EAC 30.45 IBUILDING OR WORK /� 1
(ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.20 1 I I
I - I ISEPTIC TANK, SEEPAGE PITJ I I
LIC. NO: 1 ]AND/OR DRAIN FIELD I 1
DRYWELL _
I I
] SEWER MAP BOOK: PAGE: I (ALTER, REPAIR, SEWER OR [ I I
] I ISEWAGE DISPOSAL SYSTEM I I I
I I IDISCONNECT PLUG AND I I I
] I (ABANDON HOUSE SEWER I I I
I ] I ] I I
] I IEACKFILL SEPTIC TANKS
I I ISEEP. PIT _ CESSPOOL
IGRAYWATER SYSTEM I I I
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1 I* ADDITIONAL DATA ON FILE 1 ] I 1
I I I I I I
I IREPORT ID: DPR266 ROUTE TO : BS0508 I I I I
E`GD
S& APPLICATION FORPERMIT1
a&ssa 11-ss
,DIVISION Of BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING >'
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY / A
FOR APPLICANT TO FILL IN doss ST,
LEGAL —
DESCRIPTION LOT NO., OWNER
BLOCK TRACT I MAIL
�, ADDRESS
_SIZE OF L07_ NOW ON LO7 _ _ CIT! TEL, N0.
USE OF
BUILDINGS_ :l -- DISTRICT NO. I - GROUP MAP
CON TR CT r p fil �..*i� -§+'r-' 7 "._�.. _' __ I -'- _ — ✓ ' —
ADDRESS ` ;r� -., ,. _:Y_ _._�,__-- CONNECTION DATA
_ ✓ .
---STATION =.,_' '" DEPTH .
CITY'_ 'T`-',"�L--a----TEL NO_,. '" — ----- _ —w --
MANHOLE REFERENCE
STATE.
REGISTRATION NO, /,.'--1
---
[] COUNTY
No. DESCRIPTION OF WORK FEE -.-
-4
HpUSE SEWER- S C08aNc-. TING--TO----- ._-- -- TYPE OF CONNECTIO ' _ LENGTH FROM ..o>
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�!_ I PUBLIC SEWER L $3,5 0� '��-' Y.----,-------CURB P.I l ML. TO P.L.----- ----- --'tom---
SEPTIC TANK,SEEPAGE PIT OR I
PITS AND/OR DRAINFIELD _ ([t? $3.00
-- OVERFLOW SEEPAGE PIT,DRAINF ELD -- -- ---- - P C N0,
EY.TN„C_kSSPp_O_L,DRYWELL,IFANHOLE (j: $2.00 CO. IMP. N0, �;. JOB NO.
- — ----r---
--Co.
------- W -------'- ----
._ HOUSE SEWER CONNECTING TO - I
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I1 PRIVATE DISPOSAL SYSTEM { $1.00 j �. TRUNK PERMIT NO. ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG. OR STATE ENCROACHMENT - ----__---
WORK TO HOUSE SEWER !al $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE _ ----- --------- ----------
SEWER OR DISPOSAL SYSTEM rt WASTE INDUSTRIAL
_.-__.. _ --- ---_-- r� $i,C i WASTE APPROVAL
_-__.�---- ----------- - -I-------- - CHARGES
i
_---------_--._-.-_._.-- L._-___-_---_.--_ CONNECTION CHARGE FEE
OWNER'S PERMIT ----- -- ---. _
TO
- ._-_.___----
1 HAVE AT T _— �_-—_1 00
AUTHORIZATION TOTAL FEE i REIMBURSEMENT�F:E
—APPROVALS �-DATE HNSPECiOR SIGNATURETHIS DA'T'E A CONTRACT WITH THEHEREIN NAMED CON- _ --_---_-_,-- _-- -.
TRACTOR
TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - -
TO THE PUBLIC SEWER.. NEW HOUSE SEWER
SIGNED THIS OF--_ _IS__ -e. CONNECT ADDITIONAL I I ~
OWNER OR 1 BUILN OR WORK
OWN FPS AGENT _.� EPI ANK,SEEP,PIT(S) -- _ ----
c AdD/OR DRAINr1ELD -
._
( HEREBY ACKNOWLEDGEE THAT HAVE READ 'H15 APPLICATION CESSPOOL L? DRYWELL❑
AND SLATE Tri THE !'HOVE IS CORRECT AND AGREE CO COMPLY _ .- � __1--__ ___.-,_—__—,
V NTH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR SEWER OF
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT l AM PROPERLY REGISTERED AN6'OR - -- -- �'--- �-�-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND i
CALItORNIA OR THAT I AM ,'L LEGAL OWNS OF..THE.ABOVE ABANDON_HOUSE SEWER
DESCRIBED REa1D AL PROP '�Y. ” # BACKFILL SEPTIC'TANKS❑
SIGNATURE i' -J .> SEEP. P T($) L] CESSPOOLS[I I
OF PERM LTTE J rr I I
J-OHN A,LAMBIE, COUNTY ENGINEER r LIDATION ROBERT A. WOOD,CHIEF PLBG. INs1 ECTOR
C 4 2,15r CTX p lt'} 1 C3 P1