HomeMy Public PortalAbout5231 SERENO DR_Sewer__ 9OR 662 It BB APPLICATION FOR PERMIT 1
DIVISION OF B=ING AND SAFM SEWER-SEWAGE DISPOSAL
DoPmrDLonf of Coututy Engbww
Comfy of Los ABBE BUILDING /
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
m CJIBBATTD GRIFFIN BW TOPBwLDmG LOGLITY
FOR APPLICANT TO F= IN CROSS SST
LEGAL OWNER
DESCRIPTION LOT NO
MAIL
BLOCK TRACT —1'3 ADDRESS
IV v
NO OF BLDG! .j CITY TEL
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO GROUP I YAP
BUILDINGS
ER PG
CONTRACTOR
/ CO ON DATA
Z--
ADDRESS
i
/ STATION S DEPTH
CITY NO MANHOLE REFERENCE �}
❑ STATE / LOWER
REGISTRATION NO ❑ COUNTY
No DESCRIPTION O WORK FE
HOUSE SEWER CONNECTING TO TYPE OF 1 TION LENGTH FROM /
PUBLIC SEWER @ S S So Y C RB P L Y L TO P L , Q
SEPTIC TAN K.SEEPAGE PIT OR
PITS ANO/OR GRAINFIELD @ 3!DO
OVERFLOW SEEPAGE PIT GRAINFIELD P C NO
EKTN CESSPOOL,DRYWELL MANHOLE ® $2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ® $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CON N ECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER ® S 100 PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® 11100 WASTE APPROVAL'
CHARGES
CONNECTION CHARGE FEE_
OvIm'$ PE DW S 1 00
AMORMATION TOTAL PEE REIMBURSEMENT FEE
I NAVA AT THIS DATE A CONTRACT WITH THE HEREIN HAYED CON- APPROVALS OAT# S (GNAT RHS
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISWING DWELLING
TO THE PUBLIC 9 NEW HOUSE!EWER
SIGNED THI DAY OF 19%0 CONNECT ADDITIONAL At
OWNER OR BUILDING OR WORK
OWNERS AGENT_ SEPTIC TANK SEEP,PITS)
ADDRESS AMD/OR DRAINFIELD
I HEREBY ACKNowTEDGE THAT T HAVE READ THIS,&VLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 13 CORRECT AND AGR 0 COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR !EWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES C ANO !TATE OF ABA
DCALIFORNIA ESCRIBED RESDENTIARTY NOON HOUSE SEWER
IL LEGAL ER OF THE OV BACKFILL SEPTIC TANR9❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS
OF PERU ITTEE
JOHN A LAMBIE COUNTY EN NEER VAIMATION� ROBERT A WOOD,CHIEF PLBG INSPECTOR
u ■ o -
1 ,�CO0 6 9 6 Ja 26 4 4.5 0 n
,
• COMM OP LOS ANGELES TEMPLE CITY a osoe SEWER PERMIT
DEPARTMENT OF PUBLIC MORNS 9701 LAS TURKS BE 0508 0609260013
_ BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (676) 385-0488 EXT
LEGAL. ID SEWER I SEPTIC SEVEN BUILDING ADDRESS
EK 67 PG 74 PC 7 RKIET OCC ORP 5131 SERENO DR
SLOGS NON ON LOT - TEMP CA 917803044
ASSESSOR INFORMATION NUMBER CONNECTION "PH NEAREST CROSS STREET
5388-019-037 ORIGINATION - THOMAS PAGE 596 GRID H4 LOCALITY TEMPLE CITY, C
LENGTH ML TO PL STATION DEPTH
TRUANT MANHOLE REFERENCE UPPEE/LOVHR ISSUE] ON PROCESSED BY EXPIRES ON
09/76/06 JK 03/25/07
COUNTY IMPROVEMENT NUMBER
OWNER TEL NO _ PLAN CHECK NUMBER PI TB FINAL HY CODS _
LIU CHRISTINE (676) 786-0081- JOB NUMBER
v[I
70503 SIMON COURT TRUNK PERMIT NUMBER
/ fC� -
MALNUT, CA 91789 ROAD PERMIT NUMBER DESCRIPTION OF WORK '�
APFADAVIT NO CONNECT FOR NRM CONDO TO PUBLIC SEER
WAIVER NO
APPLICANT TEL NO RABEMENT NO
HYDRO TECH PLUMBING CORP (676) 443-6366-
2609 STROEIER AVE - RECORD INSTRB®T HER RECORD DATE SPECIAL CONDITIONS
RL MONTR, CA 91733 HIGHMAT/STRRET WIDENING
STATE ENCROACHMENT PERMIT NUMBER _
CONTRACTOR TEL NO _ FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
HYDRO TECH PLUMBING 6764436366 (676) 443-6366-
7609 ST'ROXIER AVE LIC NO FEE DESCRIPTION QUANTITY DOM AMOUNT NEW HOUSE SEER
RL MONTE CA 91733 725263C36
O1 PERMIT ISSUANCE PEE 27 75 CONNECT ADDITIONAL
03 COMB TO PUBLIC SEVER 1 00 CON 46 95 BUILDING OR WORK
ARCHITECT OR ENGINEER TEL d0 TOTAL FEES 74 70
LER, PETER (676) 780-9000- SRPTIC TANK SEEPAGE PIT
0748 VALLEY BL LIC NO AND/OR DRAIN FIELD
ROSE MEAD CA 91770 775763C36
DRTWSLL
BEER MAP BOOK PAGE f ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEVER
BACKFILL SEPTIC TANKS _
SEEP PIT CESSPOOL _
GRAYVATRR SYSTEM
1
' • ADDITIONAL DATA ON FILE
+ REPORT ID DPR266 ROUTE TO 880508