HomeMy Public PortalAbout5027 SANTA ANITA AVE_Sewer__ 76A6
.663}5.89 - APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING y
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT QF BUILIDING LOCALITY
7DESCRIPTION
R APPLICANT TO FILL IN
NEAREST. .
LEGLOT NO.JOWNERAIL
TRACT M_
NO. OF BLDGS.
SIZE OF LOT _ NOW ON LOT CITY TEL. NO.
USE OF DISTRICT N0. GROUP MAP
U
---B --ILDINGS - - --
BK PG
CONTRACTOR
ADDRESS
CONNECTION DATA
- ----------------_
STATIGN �
CITY TEL.NO. T— - DEPTH UPPER
-- MANHOLE REFEREN E
STATE —_ .. LOWER_
REGISTRATION NG. -� Crl COUNTY �,•''
No. DESCRIPTIOROF MRK FEE r' ---- — --- --
- -- - - ---- `------- TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO
Y. CURB P L',� �`7d L.TO P.L.
_
PUBLIC SEWER _ _ @ $8.50 ---.-•-------
SEPTIC TANK SEEPAGE`PIT OR - - -
. PITS AND/OR DRAINFIELb
OVERFLOW SEEPAGE PiT DgAINFI D
EXIN ,CESS POG,,DRYWELi.,'!g'>, OLE r $2.00 Pe NO.
HOUSE SEWER CONNECTING
PRIVATE DISPOSAL SYSTEM -.r. $i:OG i- I TRUNK PERMIT NO. � ROAD PI RMIT NO.
CONNECT AGDIT[ONAL6 G.OR STATE ENCROACHMEr
WORK_TO HOUSE SEV _ (a $1._00 PERMIT NO..
ALTER,REPAIR ORANDON HOUSE INDUSTRIAL
SEWER O4 D15P)S SYSTEM $1.0!3 WASTE APPROVA. /
i ----------------------
--- -' ---- - .r
I_ s CHARGES -s
CONNECTION CHARGE FEE '� y ✓ -
OWNER'S PERMIT - -
-_-------------_ I. _._..__1 00_,_ REIMBURSEMENT FEE Y
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONAECI THE ABOVE DESCRIBED EXISTING DWELLING II
TO THE PUBLIC SEWER. NEW HOUSE SEWER,
SIGPJED THIS .__—_DAY CONNECT ADDITIONAL
OWNER OR 6-U1LDINO OR_WORK -
OWNERS AGENT-_ -_. . . _---_-._ -----.-_.—_-- I
'-`-" `- --' --'- SEPTIC TANK,:SEEP,PIT lS)
ADDRESS.-_--.—_ _� __-- AND/OR DRA.INFELD
I HERr6Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESS POOL LJ DP,YWEL.L!J
AND STATE THAT THE ABOVE IS CORRECT AND. AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LA'.NS REGULATING ALTER,REPAIR,SEWER OR I
PLUMBING AND. SEWERS. SEWAGE DISPOSAL SYSTEM
I 14F.REBY CERTIFY THAT t PROPERLY REGISTERED AND/Oft -_ _._- --------------.-�---.--:---.---�------.
f+tA PRO.E. DISCONNECT PLUG AND I
L'• CENS4D AS RECUiRED BY LOS AN.3ELES COUNTY AND SPATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AAI THE LEGAL OWNER OF THE ABOVE --- -- -.-I-- ----.�------------------
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS❑ '
SIGNATU RE L-� s - -L
- - �------
SEEP.PITIS� CESSPOOLS
OF P ER M I T'T EE '�'L' 'i--�i.,s,,.- .�{,_ '��---•`` -= -- f 1
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATIQK .:` .b OBER.T A. WOOD, CHIEF PLEiG. INSPECTOR
CiC. b. G. yp� CASH -
'��i.,+'--•^�.-�e�"'�fin= ,
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS BE 0508 9708070004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
L SE SEPTIC: S BUILDING
TR: 13363 LT: 16 EXIST OCC GRP: 5027 SANTA ANITA�AV
BLDGS. NOW ON LOT: TEMP CA 917803618
ASSESSOR rNFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET:
8574-009-017 ORIGINATION: THOMAS PAGE: 597 GRID: D4 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED 0N: PROCESSED EXPIRES 0 :
08/07/97 TC 08/07/98
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. 0: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
MARTINEZ RAYMOND A;RAFAELA (818) 442-6645- JOB NUMBER:
5027 SANTA ANITA AV TRUNK PERMIT NUMBER:
TEMP 917803618 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO CONNECT ADDITIONAL PLUMBING FOR ADDITION TO HOUSE SEWER
WAIVER: NO
APPLICANT: . NO: EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET WIDENI!NG:.--' ,--a
STATE ENCROACHMENT—PERMI "NUMBER-
CONTRACTOR: TEL. N0: ,, �'=S �_ == _ —FEES TAI•D. APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER ,�-,:/'�= .. �
LIC. NO FEE.DESCRIP.T,•ION'e - -'OUANTITYe'•UOM:;::' AMOUNT: W US SEWER
��� .,sem• �
01:=RERMIT•;ISSUANCE FEE27.75 CONNECT ADDITIONAL
13 WORK-TO.HOUSE SEWER 1.00EAC, s 30.30 BUILDING OR WORK
ARCHITECT OR ENGINEER: 0: TOTAL-,FEES 58.05
SEPTIC K, SEEP G
LIC. N0: AND/OR DRAIN FIELD
DRYWEL
SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT G AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS _
SEEP. PIT CESSPOOL
GRAYWATERS TEM
REPORT ID: DPR266 ROUTE TO BSO508
APPLICATION FOR PERMIT 1
&E•Bfi3 fY-55
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
Department of County Engineer
County of LOS Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER _ ADDRESS 7 w�
CASSATT D. GRIFFIN, SUP-1-OF BUILDING LOCALITY 7 e -�FOR APPLICANT TO FILL IN _ NEAREST__ T. 4
LEGAL s
I OWNER
DESCRIPTION LOT NO. (�-,_ �!( _�`(,�=7..'sl..y,,:�
BLOCK TRACT / ,� q MAIL
SIZE OF LOT f es,( NOy. OO_N_BLOTS
--�-�_ CiiY - TEL. NO.
USE OF pl
y�
BUiLDINGS' Yg�;) - DISTRICT NO. I GROUP MAP
-- - - '---r— ✓ ,k- -- ter' r" BK PG
CONTRACTOR aC Aly . y
CONNECTION DATA
A-JDRESS
- _
. ;;y STATION /,r � DEPTH t.
CITY 4.... TEL. NO. -- ' �_
- - MANHOLE REFERENC .f r 'UPPEF.
STATE � F_
REGISTRATION NO. C ❑ COUNTY
NO i DESCRIPTION Or WORK FEE -------- -- --
-_ .- — -_ -- - ---- ----- - --TYPE OFCOt LECTION LENGTH FROM
d HOUSE SEWER CONNECTING TO I '-a q, y, M.L.TO P L.
SEPTIC TANK SEEPAGE PIT OR °~
PIT$AN" OR GRAINFIELD 3.0 1
OVERFLO4Y SEEPA6F PIT,DR,+INriELD - --- - - P. C. NO.
EXTN.,CESS.POGL.,DI- V ELL,b.ANHOLE (a:, $2.00I� CO. IMP. NO. -_ JOB —_-
I HOUSE SEWER CONNECTING TO 7 ',
PRIVATE DISPOSAL. t SYSTEM 4 1.00 1 � — TRUNK PERMIT NO ROAD PERMIT NO,
I CONNECT ADDITIONAL 9LDG.OR
h WORK TO HOUSE SEWER (u s t.OG ER.Mt1 NO.
ALTER. IR OR ABANDON HOUSE - -- ------ --_.--'------- T- -
EWER OR DISPOSAL SYSTEM c� ,$ ,jI NDUSTRIAL - r
--- — -- -- — -. --_ _.__
ASTE APPROVAL
kv' a
ONN 6
K3MMF'.R'Sa - PERMIT - - -'- ----- -. ---- �—__ —.
-- ------- -- -- i---- EIMBLRSEMEN i FEE
AUTHORIZATION TOTAL FEE S
!
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON• PROVALS `i DATE i1NSPECTOR'SSIGNAIURE
- -
A.i~1 iR TO CJhNr..:I ]HE IahsOVE DESCRIBED EXISTING DWELLING i i
To .t P1„sLIC S 4rER. NEW HOUSE SEWER j.
SIGNED THI ___DI~Y CF -�. 19 20 CONNECT ADDITIONAL
OWNER OR — -
UILDING
SEPT C TANK,sEvP PIT-S .---
q'IL'NERS ADEN l 1
.. m. -, ,
ADU'r'tLSS.--_ �'' �� "U- _._ "°•� 'D' A D%GR URAINFIELD
I HER.l3Y ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ..w� P
T BO IS CORRECT AND AGREE TO COMPLY .-�FSb' 001:�.� DRY WELL[j
:97ti'.D LITE ,I AT T:{k. A.�.:Vc __.. _ _____ ..---.._.--__—.
Wi.TF1 .ALL COUNTY ORDINANCES AND STATE L.,-AVS REGULATING ALTER,REPAIR,SEWER OR �
PLUMBING AND S.W ERS SEWAGE DISPOSAL_SYSTEM.
1 FERE..' CERTIFY THAT I AM PROPERLY RFGiSTEP,ED ANVOR L'tSCOtyNc T PLUG ANL -------'--------'-----
LICENS£L AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNI.iA OR TH:AY I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DE"CRIBED R.ESIDENTiA.I PROPERTY PACKFILL SEPTIC TANKS IJ
SkFP. IIT S1 i-j CESSPOOLS y -
SIGNATURE
Y � IOF PERMITTEE_.._...�.
I'OHN A. LAMBIE, COUNTY ENGINEER VALIDATION POBERT A.WOOiD, CHIEF PLEIG. INSPECTOR
M.0. GASH