HomeMy Public PortalAbout6039 SULTANA AVE_Sewer__ ' COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0301240025
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL D: E S P C: G
TR: 5904 LT: 295 BL: .001 EXIST OCC GRP: 6039 SULTANA AV
BLDGS. NOW ON LOT: TEMP CA 917801550
ASSESSOR INFORMATION R: CONNECTION TYPE: NEAREST CROSS STREET: GARIBALDI
5384-016-025 ORIGINATION: THOMAS PAGE: 596 GRID: H3 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TEN MANHOLE REFERENCE: UPPER/LOWER: ISSUED PROCESSED BY: EXPIRES 0 :
01/24/03 JK 07/23/03
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL 0: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
LANA THUY DANG (626) 390-9646- JOB NUMBER:
6039 SULTANA AV TRUNK PERMIT NUMBER: 4b
TEMP 91780 ROAD PERMIT NUMBER: SCR P 0 0 0
AFFADAVIT: NO CONNECT GUEST HOUSE TO SEWER LINE
WAIVER: NO
APPLICANT: 0: EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET.WI:D-EN.I:RG'_�
STATE ENCROACHMENT PERM.IT.;;NUMBER:---.
CONTRACTOR: TEL. N0: �
�,� FEESIAI•D APPR A S DATE INSPECTOR SIGNATURE
SAME AS OWNER - y ®/ \i' ��®
LIC. NO ����D��I•PTION:� OUANTIT UOW' AMOUNT: WHOUSE-SEWER
r 01 PERgIyIT ISSUANCE FE 27.75 CONNECT ADDITIONAL
,19 CONNLADDTNL BOG(S')� X1.00 EAC �� 30.45 BUILDING OR WORK �3
ARCHITECTOR ENGINEER: 0: `4, ti TOTAL FEES 58.20
PATRICK CHIU AND ASSOCIATES (626) 308-9983 I \ `\ C
1238 S GARFIELD AVE LIC. N0: — 1 AND/OR DRAIN FIELD
G P
ti
#202 NONE
CA 91801 NONE -- E_ l�`ti 1` R —
SEWER MAP BOOK: PAGE: C Ji �� ALTER, REPAIR, SEWER OR
L- U F1151 l�ll(�� jII `�� SEWAGE DISPOSAL SYSTEM
9 Li u` 1� lI --— L-- -- DISCONNECT P G A
Vi- ABANDON HOUSE SEWER
'{' `, i 1 ; r C SEPTIC TANKS _
SEEP. PIT CESSPOOL
�`. I i J ti,✓i � �I
GRAYWATER SYSTEM
Servic it.,
REPORT ID: DPR266 ROUTE TO : BS0508
24650 fkS-E*T§S
`6a64,2.D
6.60
�sAsh APPLICATION FOR PERMIT
.ax,o COUNTY OF LOS ANGELES SEWERS"'—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
- `
BUILDING AND SAFETY DIVISION BUILDINGADDRESS
1LILT A. LAMBIE, County£n eer —
WL%X A.JENSEN, Supt of Building LOCALITY
NEAREST
.FOR APPLICANT TO FILL IN GROSS ST.
LEGAL
DESCPTPTI4N LOT NO. Z-J' ��+ aOWNER -
BLOCK TRACT -: _, MAIL
-..
J ,:. �- ADDRESS `-
N0.OF BLDGS '
SIZE OF LOT NOW ON LOTa.__ ' CITY ' , TEL. NO.
USE OF
BUILDr GS i L� DISTRICT N0. GROUP. MAP OCESSED BY
CONTRACTOR ;. '--. �! �— •+; y i�. �:--- ��fJ' -f �' _... � +._.. -
ADDRESS 4/ — CONNECTION DATA
CITY ' ?~ EL ` STATION 7y-- ' > DEPTH .
y'� y STATE MANHOLE REFERENCE UPPER
REGISTRATION NO_-w:.�r,_S ,: :'' 'E° °�. COUNTY LOWER
NO. DESCRIPTION OF TNORK FEE
j
HOUSE SEWER CONNECTING T3
__PUBLIC SEWER QP $3,00 TYPE OF CONNECTION M LENGTH FROM -
SEPTIC TANK SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L_
PITS AND/OP DRAINFIELD 33100
OVERFLOW SE--PAGE PIT. DRAINFIELD
EXTN . CESSP40L DRYWEL.L @ ,$2.40
HOUSE SEWER CONNECT NG TO ., P.C.N0.
PRiVA'TE Di S.POSAL SYSTEM1.i _ C� $P.40 CO.IMP. P70, P - JOB N0. .yg
CONNECT ADDITIONAL E SBLDG OR.g" TRUNK,PERMIT NO. ROAD PERMIT NO. 0
WORK TO HOUSE SEWER%°fes f S4`E- r $,_DO ate.
ALTER.ER.REPAIR OR ABANDON HOUSE c � STATE ENCROACHMENT 9
SEWER( DISPOSAL St STEM C SE00 PERMIT NO. O
INDUSTRIAL
U
- WASTE APPROVAL Y'+S
CHARGES
OWNER'S PERMIT S . £ , 00 CONNECTION CHARGE FEE
AUTHORIZATION� TOTAL FEE ��_ REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE IPEG7'OR'S SIGNATURE
TO THE PUBLtc. SEWER
SIGNED THISDAX DNEW HOUSE,SEWER
OWNER OR OWNERS AGENT " — CONNECT ADDITIONAL
BUILDING OR R WORK - -
"' SEPTIC TANK,SEEP.PIT(S)
ADDRESS - �', "'`.. '�:.'"' AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL 0
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE
NECT PLUG SYS
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCOABANDON HOUSE SEWER
ND
CALIIFOP.NiA OR THAT 1 AM THE LEGAL...-OWNER OF T)m ABOVE
DESCRIBED RESIDENT %,F PROPEit7Y –` �/ ;' BACKFILL SEPTIC TANKS
SIGNATURE % �' ,�� �' " SEEP.PIT(S) CESSPOOLS (].
OF PERMITTEE .'i %. _• ",1'"
7P
VALIDATION ROBERT A. WOOD
CK. Y.o. CASH SUPERVISING MECHANICAL ENGINEER
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