HomeMy Public PortalAbout6133 SULTANA AVE_Sewer__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0308040017
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL - ER .
S P B D S :
TR: 5904LT: 186 EXIST OCC GRP: 6133 SULTANA AV
SLOGS. NOW ON LOT: TEMP CA 917801552
ASSESSOR0 A ON B CONNECTION TYPE: NEAREST CROSS STREET: LONGDEN
5384-006-026 ORIGINATION: THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
MANHOLE REFERENCE: UPPER/LOWER: ISSUED 0 ROC DBY: EXPIRES .
08/04/03 JK 01/31/04 -
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. 0: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE-
TORRES LUIGI;MARY 0 - JOB NUMBER:
6133 SULTANA AV TRUNK PERMIT NUMBER: v r' 3 (r ep•
TEMP 917801552 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO SEWER REPAIR/REPLACEMENT
WAIVER: NO
APPLICANT: EASEMENT: NO
KEVIN SHAW PLUMBING INC (626) 359-1864-
224 E FOOTHILL RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
MONROVIA HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: EL. NO: FEES PAID--- APPROVALS DATE INSPECTOR SIGN T RE
KEVIN SHAW PLUMBING (626) 359-1864-
224 E. FOOTHILL BL. LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER //�J Q
MONROVIA, CA 91016 414122/C36 + /ref,
01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
15 ALT/REP HOUSE SEWER 1.00 EAC 30.45 BUILDING OR WORK
ARCHITEC OR E G TEL. 0: TOTAL FEES 58.20
SEPTIC TANK,LIC. NO: AND/OR DRAIN FIELDG P
IT
DRYWELL
SEWERP BOOK: PAGE: ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM i
v;
DISCONN-ECT PLUG AND
ABANDON HOUSE SEWER
BACK LL SEPTIC TANKS
SEEP. PIT _ CESSPOOL
RA TER SYSTEM
REPORT ID: DPR266 ROUTE TO BS0508
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
r COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER f BUILDING
CASSATT D. GRIFFIN, SUPT OF BUILDING I ADDRESS
' FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST-- -- " -� -
ADDRESS _ _ CROSS ST.
LOCALITY, i DISTRICT NO. SERIAL NO. PERMIT NO.
_ A s
NEAREST vs v t
CROSS ST. RECE(VED,BY Ready for inspection DATE ISSUED
--
OWNER --- - }? 0 I s
MAIL ^-- -- USE ZONE OCCUPANCY MAP
ADDRESS BK PG
CITY TEL.NO. J
CONTRACTOR CHARGES REIMBURSEMENT FEE
ADDRESS T REQUIRED
---- --- ----- NOT REQUIRED
CITY -- _— TEL.NO. _— JOB NO CONNECTION CHARGE FEE
STATE CO.IMP. N0.
REGISTRATIONNO. COUNTY
LEGAL RECEIPT NO. DATE I BY
DESCRIPTION LOT NO.^�
BLOCK --- TRACT WAIVER FOR RECORDING
SIZE OF LOT__ — NO.OF BLDG$. RECEIPT NO. DATE 4 BY
_ NOW ON LOT
USE OF !
BUILDINGS TRUNK PERMIT NO.
NO. pESCRIPTI.ON OF WORK FEE
HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
PUBLIC SEWER a $ 3.50 I
_-.._ S " STATE ENCROACHMENT
HOUSE SEWER CONNECTING TO
_ PRSYATE DISPOSAL SYSTEM 1.00 PERMIT NO.
CONNECT ADOiT10NAL BLDG.OR I INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISGONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 STATION t DEPTH tia
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00MANHOLE REFERENCE
j CESSPOOL—DRYWELL I UPPER Law"
SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONNECTION LENGTH FROM
Y CURB _>--r 1l M.L.TO P.L.
OWNERS PERMIT $ I 1 00 -
AUTHORIZATION I TOTAL FEE I
I HAVE DATE CONTRACTD WITH THENAED
CONTRACTOIR TO CONNECT THE ABOVE D SCRIBEDIEXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
—
SIGNED THIS....... __._..-DAY OF. -- ----- 19._--.-- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL Ti_ --
OWNERS AGENT. _._. BUILDING OR WORK
- .-..-:_._-........_..-.- ..:,-__.,. --- SEPTIC TANK,SEEP.PIT(S) --
ADDRESS _.___:. - -_.-. _. __ _ -------- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL I] DRYWELL 0
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE -SEEP.PIT(S)o CESSPOOLS E]
-- ---
OF PERMITTEE---------- -----------..------
76A642D 663 12/52