HomeMy Public PortalAbout5921 TEMPLE CITY BLVD_Sewer__ s
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1211270001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
[LEGAL ID: SEWER / SEPTIC: SEWER I BUILDING ADDRESS: [
[ ON FILE (EXIST OCC GRP: [ 5921 TEMPLE CITY BL
[ [BLDGS. NOW ON LOT: TEMP CA 91780 [
[ASSESSOR INFORMATION NUMBER: [CONNECTION TYPE: NEAREST CROSS STREET: LAS TUNAS
18587-014-007 [ORIGINATION: THOMAS PAGE: 596 GRID: J3 LOCALITY: TEMPLE CITY, Cl
[ [LENGTH ML TO PL: STATION: DEPTH: I [
(TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: [
I I 111/27/12 SR 1
(COUNTY IMPROVEMENT NUMBER:
(OWNER: TEL. NO: IPS CHECK NUMBER: I FINAiNIATE FIFAL BY: CODE: 1
IPEARSON, ELIZABETH (562) 498-0612- IJOB NUMBER: I I
15560 LONNA LINDA DR ITRUNK PERMIT NUMBER: I I
IROAD PERMIT NUMBER: IDPSCR'IPTfON OF WORK
I 1AFFADAVIT: NO [RUNNING NEW 4" SEWER FORmLTN TO NEW RESTROM AND PIPE FOR 11
IWAIVER: NO IRESTROOM I
[APPLICANT: TEL. NO: (EASEMENT: NO 1 I
1HARRIS, RICHARD (562) 900-7356- 1 1 I
19364 BARKERVILLE AVE [RECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS: 1
1WHITTIER CA 90605 1HIGHWAY/STREET WIDENING: [ 1
STATE ENCROACHMENT PERMIT NUMBER:
II I
1CONTRACTOR: TEL. NO: 1 FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE 1
IVIKING 2000 PLUMBING (562) 900-7356- I 1 p 00I
19364 BARKERVILLE AVE LIC. NO IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT.INEW HOUSE SEWER 1 I
1WHITTIER CA 90605 965413 * I 1 I 1
I 101 PERMIT ISSUANCE FEE 27.80 ICONNECT ADDITIONAL [ I
I 113 WORK TO HOUSE SEWER 1.00 EAC 30.50 1BUILDING OR WORK I [ I
1ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.30 1 I I [
I - I ISEPTIC TANK, SEEPAGE PITI I I
1 LIC. NO: I [AND/OR DRAIN FIELD
I 1DRYWELL I I
1 SEWER MAP BOOK: PAGE: [ [ALTER, REPAIR, SEWER OR
I I ISEWAGE DISPOSAL SYSTEM I I I
I I IDISCONNECT PLUG AND
I I 1ASANDON HOUSE SEWER I I I
I [ IBACKFILL SEPTIC TANKS _
1 [ [SEEP. PIT _ CESSPOOL
[ 1 [GRAYWATER SYSTEM [ I I
I [ I I I [
I I I I I I
I I I I I I
I I I I I I
I I I
1 I* ADDITIONAL DATA ON FILE [ I [
I I I I I I
I [REPORT ID: DPR266 ROUTE TO : BS0508 I I I I
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLIOANT TO FILL IN - LOCALITY
BUILDING NEAREST
ADDRESS r LL _ / CROSS ST.
LOCALITYDISTRI CT NO. SERIAL NO. PERMIT NO.
'-fes
NEAREST 7 _ - 27 ., A c
CROSS ST j:} RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS '6 _ y'e j USE ZONE OCCUPANCY` MAP� BK PG
CITY
TEL.NO
CONTRACTOR �-rs
CO.IMP.NO.
ADDRESS JOB.N0. _
CITY TEL.NO. TRUNK PERMIT NO. e
STATE
REGISTRATION NO. (� COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. j
NOW ON LOT s CHARGES
USE OF °
BUILDINGS �, g ,. f a CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE '
HOUSE SEWER CONNECTING TO
PUBLICSEWER 0 $ 3.50 RECEIPT NO. j DATE �BY
HOUSE SEWER CONNECTING TO J
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0. DATE i BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR --
_ PITS AND/OR DRAINFIELD 2.00 I STATION DEPTH
CESSPOOL—QRYW ELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
«R LOWER._
TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. -'M.L.TO P.L.
OWNERS PERMIT $ 1 00
AUTHORIZATION I TOTAL FEE I i _ -
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
:Y ! ; NEW HOUSE SEWER
SIGNED THIS__.__. Y OEr _ -__..._..._19_ _
CONNECT ADDITIONAL
dam- ' ` fBUILDING OR WORK
OW#E t& AGENT Z t G _u r L '
y ! SEPTIC TANK,SEEP.PIT(S)
ADDRESS f�.t_i_I. _-vf�.-_fir f. G-r....._ , .:_:,u: y :* ':_ AND/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT 1 H/� E READ THIS APPLI- CESSPOOL[-] DRYWELL
CATION AND STATE THAT THE ABOVE iS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED,AS_REQU`AED BY LOS ANGELES COUNTY ABANDON HOUSE S EWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(,
SIGNATURE SEEP.PIT(S)0 CESSPOOLS 0
OFPERMITTEE--....-----------------------.-- ---------____.----_------___..__-___.._.__.---
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