HomeMy Public PortalAbout5709-5911-5913-5915 SULTANA AVE_Sewer__ COUNTY OF IAS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0906080002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT: i
ILEGAL ID: ISEWER / SEPTIC: SEWER BUILDING ADDRESS: 1
ITR: 12157 IT: 11 BL: .001 UN: .003 (EXIST OCC GRP: I 5711 SULTANA AV 1
IBLDGS. NOW ON LOT: I TEMP CA 917802354 I
(ASSESSOR INFORMATION NUMBER: ICONNECTION TYPE: I NEAREST CROSS STREET: ROSEMEAD 1
15387-029-009 �IORIGINATION: I THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY, Cl
I ILENGTH ML TO PL: STATION: DEPTH: 1
(TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSU^D ON: PROCESSED BY: EXPIRES ON: 1
I I 106/03/09 SR 12/05/09
1 IOOUNTY IMPROVEMENT NUMBER: [
OWNER: TEL. NO: JPLAN CHECK NUMBER: IF DA FI L BY: CODE:
ILEW MICHAEL (818) 642-3790- IJOB NUMBER: [
15711 SULTANA AVE. ITRUNK PERMIT NUMBER: 1
ITEMPLE CITY CA 91780 IROAD PERMIT NUMBER: IDESCkIPTidio OF WORK
IAFFADAVIT: NO 11NST_aT•r. 2# 2 WAY CLEANOUT ON SEWER ALL WORK DONE ON PRIVATEI
IWAIVER: NO (PROPERTY I
(APPLICANT: TEL. NO: (EASEMENT: NO
IBRUCE (310) 838-0408- 1 I I
13801 LANAWEE AVE. IRECORD INSTRUMENT NBR: RECORD DATE: ISPECZAL CONDITIONS: [
CULVER CITY CA 92032 [HIGHWAY/STREET WIDENING: [
I (STATE ENCROACHMENT PERMIT NUMBER: I [
CONTRACTOR: TEL. NO: 9 FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE
I•
MIKE DIAMOND PLUMBING (310) 253-5229- 1 1 I
13801 LENAWEE AVE LIC. NO IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT:INEW HOUSE SEWER I I I
[CULVER CITY CA 90232 399170 * I I I
[ 01 PERMIT ISSUANCE FEE 27.75 (CONNECT ADDITIONAL I 1 I
I 115 ALT/REP HOUSE SEWER 2.00 EAC 60.90 IBUILQING OR WORK [ I
ARCHITECT OR ENGINEER: TEL. NO: 1 TOTAL FEES 88.65 1
I I
I - ISEPTFC TANK, SEEPAGE PITT I I
LIC. NO: (AND/OR DRAIN FIELD I I I
IDRYWELL
[ SEWER MAP BOOK: PAGE: (ALTER, REPAIR, SEWER OR I I [
ISEWAGE DISPOSAL SYSTEM
IDISCbNNECT PLUG AND 1 [ I
I (ABANDON HOUSE SEWER [ I
IIBACKFILL SEPTIC TANKS I I I
I I (SEEP. PIT _ CESSPOOL
I I IGRAYWATER SYSTEM [ I
I I I I I I
i
I I I I I
I I I I I I
I I 1 I I I
[ I* ADDITIONAL DATA ON FILE I I I I
I I I I
I [REPORT ID: DPR266 ROUTE TO : BS0508 I I I I
APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D ISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS;
J CASSATT L7, GRIFFIN, SUPT OF BUILDING
LOCALITY
NEAREST
FOR APPLIC N T
LEGAL ���� --
DESCRIPTION OWR
LOT NQ Y {q�g
� � .. N
MAIL
BLOCK TRACT j' „-' - ADDRESS
NO. OF BLDGS.
SIZE OF LOT _ NOW ON LOT y :' CIT T£L. N0,USE �
PUiLDiNGsi1t DISTRICT N0. GROUP MAP
- - .� 7'..,-��' BR PG
CON'IRACTO.R >;.:.
— —
_k_
CONNECTION
_y .. — — --- —-- ---_ -- -- -- ---
ADDRESS �� CONIN CTIONI_DA -- —
E DATA
STATION - _-y,_- _ .d`tl DEPTH = _
CITY >• {^yw@ , TEL. NO. '4r' ,jam. ;'_. ---- MANHOLE REFERENCE
--:�•-r�
NATE .---------- -= -'�'-- -- � _ LO_VvER
REGTI
ISTRAON.NO. i. COUNT'aNO. j DESCRIPTION OF WORK FEE - - - -- --- -- --- --
TYPE OF CONNECTION'' ' LENGTH FROM
HOUSE SEWER CONNECTING TO I i
".'�f 'Y, _^ ,CURB a P L -' M I, TO P 1
( 1__f U B L i C S£W R —...__ L
--- --------�-
SEPTIC TANK E PIT OR r----- -----'- —_. -------------- -
PITS AND/OR DRAiNFIRAiNF[£LD GI $.5.04� �- .
OVERFLOW SEEPAGE PIT DRAINFIELJ -CO, 1MP. NO. 1 " 7 JOB NO.
EXTN„CESSPOOL,DRYWELL,M.ANHOLF, r- $ '-.40.1_----t.-----. .---.—.. _.�.d3-.-- ---- ------`
HOUSE SEWER CONNECTING TO
_ ! PRIVATE DISPOSAL SISTER? rcc � TRUNK PERMIT NO. _ � 'LOAD PERMIT NO.
j CONNECT ADDtTiONAL BLDG. OR I - - STATE ENGROACI'NEPJT' - ----. --- -- -
WORK TO HOUSE.SEWER rt �i.DG � �� � PERMIT NO.
ALTER,REPAIR OR ABANDONHOUSE I_ .�. — -- - --- ..--- -----
SEWER OR DISPOSAL SYSTEM �` I•00 ! INDUSTRIAL
-- - WASTE APPROVAL
.---I- -------.- -. _ CHARGES
OWNER'S CONNECTION CHARGE FEE
PERMIT _.. t Oo -- — ----- ---
REIMBURSEMENT FEE
AUTHORIZATIONTOTAL FEE
3
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- �--APPROVALS ( 1 47E I N S P L”G'30P S____._—_— -L -, S_�'�ATI;{?E
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING - I
TO TN:E PUBLIC SEWER. NEW HOUSE SEWER -
SIGNED TI-Its DAY Y.JDE_
CONNECT ADDITIONAL
OWNER OR f `' w BUILDING OR WORK ...--
OWNERS AGE" ' - ±k' -= - SEPTIC TANK,SEEP PIT(S) -...__.
AND+OR DPAINFIELU
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION �
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL(] -----DRYWEL I —
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR I r
PLUMBING AND SEWERS. -"j
_SEWAGE DISPOSAL SYSTEM I. --I} -
I HLR_DY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
— _—^- -- --
LICENSED AS rEt'UIRED BY LOS AN �ELE FOUN�CY AND STATE OF ABANDON HOUSE SEWER ! I
CALIFORNIA. OR THAT 1 15 THE LEGAII• OWNER OF THE ABOVE ----�-- ---- --.:_..-- --�------------
DESCRIBED RE'a�>.ENT;AL. PR ERT Y -' �' BACKFILL SEPTIC TANKS Ej
SIGNATURE
SEEP. PIT(S) L) CESSPOOLS _ --— ---------
----- -------
ft-
OF PERMITTEE
10-HN A.LAMBIE.COUNTY ENGINEER .--YALIDATION ROBERT A.WOOD,CHIEF PLBG. INSPECTOR.
0. CASH
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