HomeMy Public PortalAbout6435 SULTANA AVE_Sewer_12/8/2006_SE 0508 0612080001 COUNT3f OF LOS' INS TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS BE 0508 0612080001
BUILDING 7'.[iD SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
• PHONE: (626) 285-0488 ERT:
LEGAL ID: SEWER SEPTIC: SEWER BUILDING ADDRESS:
ON FILE EXIST OCC GRP: 6435 SULTANA AV
BLDGS. NOW ON LOT: SGAB CA 917752033
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: EMPEROR
5382-021-003 ORIGINATION: THOMAS PAGE: 596 GRID: H1 LOCALITY: TEMPLE CITY, C
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
12/08/06 JK 06/06/07
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: F NAL DME FXNAL BY: CODE:
CHIN RODNEY (818) 287-1702- JOB NUMBER:
6435 SULTANA AV TRUNK PERMIT NUMBER:
SGAB 917752033 ROAD PERMIT NUMBER: D SCRIPT ON OF WORK
AFFADAVIT: NO REPLACE 25' CLAY SEWER W/ABS. HOUSE TO P.L. DAMAGED BY TREE
WAIVER: NO - ROOTS
APPLICANT: TEL. NO: EASEMENT: NO
KAWAKAMI (626) 482-9050-
825 ORANGE GROVE PL RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
SOUTH PASADEN CA HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
YOSHIMI KAWAKAMI (626) 799-0599-
917 FREMONT AVENUE #139 LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER
SOUTH PASADENA, CA 91030 676197 B
01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
15 ALT/REP HOUSE SEWER 1.00 BAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. NO: TOTAL FEES 58.20
LI, DAVID (626) 288-1216- SEPTIC TANK, SEEPAGE PIT
2446 N. SAN GABRIEL BL.,#B LIC. NO: AND/OR DRAIN FIELD
ROSEMEAD, CA 91770 676197 B
DRYWELL
SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS _
SEEP. PIT CESSPOOL
GRAYWATER SYSTEM
* ADDITIONAL DATA ON FILE
REPORT ID: DPR266 ROUTE TO BS0508
a E663 12-5412-546& APPLICATION FOR PI P rkP-14 x
-E @.86
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGL LptzoPOSA.L.
Department of County Engineer MM
County Of Los Angeles BLtILAING
W M.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN,RUP•T OF BUILDING LOCALITY
FOR "PLICANT TO FILL IN NEAREST _
CROSS ST.
LEGAL apP ''.' r fi "F-. '✓ { - f..._, N T'' ..,ia -
OE5CRtPT1034 ICT NOt ^. ,>N iz OWNER -
BLOCK TRACT '_ p` ✓ ,e1. MAIL
ADDR :S
NO, OF DGS. ".`�'-..._.-..�.�.-
SITE OF LOT NOW ON LOT _ CY Y TEL- NO.
USE OF ----
BUILD[NGS DISTRICT NO. GROUP MAP
CONTRACTOR.__.--.... -'�f' � BK PG
ADDRESS CONNECTION DATA t
CITY _I F1: NO STATION �� /d�;f``- `�,� �.DEPTH
rr
MANHOLE REFERENCE .,
REGISTRATION NO. .- ..d.. L^I. COUNTY -_ I y,k :."�' UPPER SA+K^G'P
--�� — --*^-^ - — TYPE OF CONNEViON LENGTH FROM
NOS} DESCRIPTION OF-WOF'i; FEE _J CURB P.L:` M.L.TOP L. G
ITO US F SEWER CONNECTING TO
PqU -EVd R _ G3' $_3.50 _._..--
sl HOUSE CEWER CONNECTING TO�—
PRIVATE DISPOSAL SYSTEM t.00_I ---
CONNECT ADDITION A.L BLDG. OR ! '.-- - CO. 1MP.NO. ✓� F &-'k JOB. NO.
WORD:TO HOUSE SEWER 1.00 ._-- --
ALTER OR REPAIR EXISTING
S�`NLR QR Di POSTAL SYSROAD PERMIT NQTEM 00 t. TRUNK PERbtIT NO.
DISCONNECT AND ABANDON SEWER - I
I $TATE ENCROACHMENT
T
AND/OR DISPOSAL SYSTEM f 00 �� _A PERMIT NO.
ScPT1C �A*lY S EPAGE PIT GR S INDUSTRIAL �` ---�---
PITS ANWOP DR,INFIELD _2;00 '_. WASTE APPROVAL
CESSPOOL DRY%VEL L
SPECIAL CONDITIONS ONLY _2.00 CHARGES
CONNECTION CHARGE FEE
OVVNER
D.Ok
PERMIT $ 1 OCI -_ �___�—_-..—.---------
AUTHORIZATION TOTAL FEE - REIMBURSEMENT FEL
I � s =
1 HAVE Tt±iS DATA CONTRACTED WI ;-I. - E HERESN NAMED CON- Tq
'TRACTOR 'TO CONNECT THE ABOVE D CRits`ED EX S!1£dG DJarLLING APPROVALS DATE INSPECTOR'S S;GNATURE
TO THE PUBLICR -. �, �...-
-' - NEW HOUSE SEWER
SIGNED THIS �-_- e�Y ----
,{� CONNECT ADDIT'ONAL -
01^IEdr"-'i OR ' _y' -�-,. '9�.?,r�_,Y BUILDING OR WC RK
OWNERS' A, NTT.
- SEPTIC TANK, SCEP,PIT(S)
`ANNOR DRAINFILLD
1 ti=REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL C] DRY-WELL[3
AND ST'AV'E THAT THE ABOVE 15:CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LIDS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _-A_B_ANDON HOUSE SEWER
.DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS
SEEP.PIT(q) (]. CESSPOOLS,]
.SIGNATURE - ,�✓,:,' _- _--� .�---
OF PER.MITTEE_��.1.,.:. -
NONE= W
hVILLIIAM J. FOX,COUNTY ENGINEER VALIDATION
BY BY
DEPUTY DEPUTY
BY BY
-8 DEPUTY - DEPUTY