HomeMy Public PortalAbout5742 ROWLAND AVE_Sewer__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SE 0508 9805260003
gUILDING•AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL ID:. SEWER / SEPTIC: S BUILDING ADDRESS:
TR: 6561 LT: 396 EXIST OCC GRP: 5742 ROWLAND AV
BLDGS. NOW ON LOT: TEMP CA 917802616
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET:
8587-034-016 ORIGINATION: THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
06/03/98 UT 06/03/99
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY; CODE:
MORGAN GREGG D;BRENDA K - JOB NUMBER: 1 i 9 3 P(�� 1n .
5742 ROWLAND AV TRUNK PERMIT NUMBER: h 1`
TEMP 917802616 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO CONNECT GUEST HOUSE TO PUBLIC SEWER SYSTEM
WAIVER: NO
APPLICANT: TEL. 0: EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR:-=-=-__ =s RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET WIDENING:--- v
STATE ENCROACHMENT-,PERM IT=NUMBER::'-
CONTRACTOR: TEL. N0: ",i' FEES-,', �''PAID. APPROVALS DATE INSPECTO I"GNATURE
SAME AS OWNER - 'v-- -
LIC. NO FEE DESCRI. P.TION: �'' QUANTITY: UOM: AMOUNT: NEW HOUSE SEWERf L10
01'PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
19 CONN ADDTNL •BLDG($) `1.00 EAC 30.30 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. NO: -TOTAL' FEES 58.05
SEPTIC TANK, SEEPAGE PI
LIC. N0: - - AND/OR DRAIN FIELD
DRYWELL
SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS _
SEEP. PIT CESSPOOL
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO BS0508
, E
& -66 E-663 9Y-5fi APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER _ADDRE55
CASSATT D. GRIFFIN, SUPT 01;BUILDING LOCALITY
-- - '--�
FOR APPLICANT TO FILL IN NEARESTcRosS_sT.
LEGAL
DESCRIPTION LOT NO. .'� / OWNERMAIL
r
BLOCK TRACT _ W_r,, ADDRESS
1—
NO. OF BLUGS.
SIZE OF LOTr NOW ON LOT __ % CITY ✓ .4 TEL, NO.
USE OF
BUCLDINGS` �i •;�✓.,��_...,.°' '" ,''' y ..I€'� DISTRIICCTNO. ! GROUP I MAP
BK PG
CONTRACTOR l. �x� �. I k-�
T y
ADDRESS r CONNECTION DATA
v� .� � ,y � �: � � - � e -
el _ d
CITY L2 TEL. STATION J• 3°"" ,'�' `, DEPTH {�,�-,•
Pio , ` i 1 ti --=#-- ,
— MANHOLE REFERENCE , , .C:�y r� a. UPPER
STATE _�.._ � ��.:°$�So�T"LOWER':
REGISTRATION NO,� �� COUNTY
No. L DESC.RIPTION OF WORK_ _ FEE - —.-- -- -----�.—...
j HOUSE SEWER CONNECTING TO TYPE OF-�y� NECTION LENGTH FROM
9 _PUBLIC SEWER @ �_ � I .Y. �_ �"^'-`g P.L. M.L.TO P.L,
SEPTIC TANK,SEEPAGE PIT OR y
_- I PITS AND/OR DRANFIELD G $3 D
-" -- - - ----. _.— --
OVERFLOW SEEPAGE PIT,DRAiNFIELD - - :+' ,, J C. O.
EXTN.._CESSPOOL DPYIN LL MANHOLE G $2.00 _CO_INP. N0. �, .✓d;.r 106 N0.
I HOUSE SEWER CONNECTING TO
_4 PRIVATE DISPOSAL SYSTEM cz` $I,0_0 _TRUNK PERMIT NO,_ ROAD PERMIT NO.
— CONNECT ADDITIONAL BLDG,OR t -STATE ENCROACHMENT
WORK TO HOUSE SEVER G
$L00 - �j PERMIT NO. _
ALTER.REPAIR OR ABANDON HOUSE -- _-�- ------------ "-----^—`—
SEWER OAL
R DISPOSAI SYSTEM (z $I.00 - WASTEINDUSAPP
-- "----- -- _--_ __.—_ WASTE APPROVAL - -
--- CHARGES
.._.^__ CONNECTION CHARGE FEE
OWNER'S i4l
AUTHORIZATION TOTAL FEE y.
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN VAMED CON- _ _ APPROVALS DATE. INSPECTORS .IGN,ATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO 'THE PUBLIC SEWER, . NEW HOUSE SEWER i
SIGNED THIS ; ,a DAY OF /
r �.�_". Io O - — - - - - -- --
�,. CONNECT ADDITIONAL
OWNER OR BUILD NG OR WORK
OWNERS AGENT--
zy r " .�! f' '.._--- - ---- --__.— -------�----- - -- ----
SEPT TANK,SEEP,PITS)
.—
ADDRESSw - lv✓7' AND/OR DRAINFIELD
I HEREBY P KNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL J CRYVJ£LL
AND STATE TH ,'T THE ABOVE IS CORRECTAND AGREE TO COMPLY - _-__ _—_
�k-ITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR,SEWER OR
PLUMBING AND SEWERS. _SEWAGE DISPOSAL_SY_S_TEM_—i --�-
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR - _- - - -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND �
CALIFORNIA OR THAT I AM THE LEGAL OWNER. OF THE ABOVE __ABANDON HOUSE SEWER
DESCRIBED RESIDENT L,PROPERTY, BACKFILL SEPTIC TANKS r]
.a SEEP.PITS)LJ CESSPOOLS❑
SIGNATURE ��' _ —. _ _.
OF PERMITTEE v` - ------ i --
I i
JOHN A. LAMB E, COUNTY ENGINEER VALID SA TIO ROBERT A. WOOL),CHIEF PL>3G. INSPECTOR
CK. k. O. CASH rT,
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