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HomeMy Public PortalAbout6135 TEMPLE CITY BLVD_Sewer__ APPLICATION FC. , PERMIT COUNTY OF LOS ANGELES SP-WER--SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION I�, I—-,IN G JOA. LAMBIE, CountV Enginoo� HN ------- WILLIAM A. YENSEN, Stcp` of Bailding R 0 L S �T� FORAPPLICANT TO FILL IN 4-" LEGAL 'Rl PTI ON N L T A cl h r-)0 r,F's S, NO. OP BLDGS, SIZE Or 1_01 NOW ON Lor -F NO FjL lN G pi EqsF_.-' -- -------- D�STR�CT NO. GROUP MAP ROD 8, C : P C. 4 �NTRACrOR A D D RESS, CONNECTION DATA c. STATION UIFPTl EL. D STATE M,A N H 011 F RF'EftNCE RREGIS,RATIDN cc)UNT" 4 -M-0 L)E�SCRIPTION 0Y7 WORK F E E TyvE OF CoNpjac-10T.4 L.ENGTH FROM —USE.SEWEk rONNECliNG TO Y CUNIZ r.L. M.L.TO P.1_. < Puw-1c t��YVKR o P.C.NO. S�-TjC TANK.S E E III A G Z:P;I OR u PITS AND ICIR DRAT N r�,C.1-0 # $10.00 CO, IMP. No. JOB NO. HOUSESEWER CONNECTING 70 rRUNKPER'I'[ RqRt)vpsRr4-/ r4,6 PR ATI DISPOSAL SYSTEM @ $3.00 Al- INSTR. NO. v' DATE L) fONAL BLDGOR REC . 'ORD�, -ONNF.(,T ADOlT WORK TOHOUSE SEWER_ $3.00 Qt LRF SEEPAGE PIT-ORAINFIELD MA 101 OLE $5.00 A X, H INY,OR ST.WIDENING OL. FR-REPAIR�YR AEIANDON HOUSE @ q.3 oo AT.�,Elvrw�rq CIR.D 9 1 T -E ENCROACHM LN-T PERMIT N11. iNDCJSTRfAL I v,VAST8 APPROVAL OWNER'S PE CHARGES _w .iT $ 2 loo,-� AUTHOMATION TOTAL FEE C,'ONNECTiON CHARGE FEE I HAVE AT TH;S DA r A CINIO'RACT WITH -,HE HEREIN NAMED CON- RFIMSURSEMENT F'ZE. I - - I J_ 'TO TO "T CRje;Ej, ELL) 1-7�,l I,TOR CONNEC THF ABOVE DES Ly�IS LLN G DW N`G TO THE '­JrL.!C APPROVALS DATE i?j8k-Ec-rows SiGN-rURE SiGNED TF-)!S,--.. 0AY OF---' WNEJ"OR NEV, HOUSE SrWR DWINIER15 (ONNCCT AQDd7 IONAL UILCIFOPWORK _z SEPTIC TAN F'I-r S) I i tEREBY ACKNE OWLEDGTH81 A HAVE READ VIIAl 10N ANDIOR ORF'i F ANCI_ SiRTE. HAT THE AElDVE i' CORRECT AND AGR<_E Tel COMPLY ,It . COUNTY ORDINANCES AND STA7E LAWS REGULATING I IN G ANO SEWERS. RYWELL PROPERLY REGIS-ERED AND/OP ,LTE-R.REPAIR,SEWE I <EBY ':-,ERTi5Y ','H A[ I AM _p OR LI(�E�NSFU AS LO ANGLEI�; COUNTY AND $TATE 0 F SEWAGE DSPCSAL SISTF-M By f5 C i - ______- ___- ALtFORNiA OR THAT I AM 1�,E LEGAL OWNVR Of, AND INTEND TO _W�CONNE:Cl' PLUG ­N' e T F t-55DE IN. 7HE ASOVE DESCRiBIED RESiDENIiAL PROPERTY. ALAN I40USE S�_WE�) LS t G.,,;3.T P;I Rl E CKV I L-SEPT TAN'KS _7 -E OF' ERMITTEE- SA L Ct:SSPOCLS ROBERT A. WOOD ALIDATION BES'UPERVISN14G NTECHANiCAL FNG:NEER 6A542D APPLICATION Fl- R PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL BUILDING AND SAFETY DIWSION I ]-IN A. LAMBIEr 0 COW'dy Engnear j 4W4 WILLUM A. JENSM Supt Building N E AR'-7 5 T S . '771 FOR APPLICANT TO FILL T OWNER V MAI?Ul;-0 CK AODRFSS No- OF SlzEo- LOT Now 0 Pf Lor CrTy NO, 11 DIST !CT NO. GROUP MAP PROCESSED BY OR CON;14AC I A D D RE CONNECTION DATA X,7 lyr 10 N DEPTH CATY El- -El If MANHOLE R�-FERENCE, S, 'I<r-``"N' 1, LOWER -R: .4 0 7 COUNTY NO. EF�-`­RIPCi-SN OF WORK FCE TYPE.Or 9--ONNECTION.�` L2G7m F-RONt.. H0,J5F SEVVEF,C0NNZGIl TiC TO Z Yop.L, $s ooe, 0 S'E."Y'l l,"AN K,9 -- - - -- - I ­, , ,I :"; P.C.No. , EPA E F;F OR JOB N,0. DRAtNFir,.1-0 @ 1000 co. IMP. NO. TRVNK PERMIT N 0 Sr -C r, c, tar P E RM I T�4 -wr.p ­)N�4L F V k 7 P &t5 rfirt « $,3�00 C NXj BLc,-:-c-7i C, ,NEG-N. A D D I T�Q wAkycg i EASA1,1,T RECOaa m S T P1,No, EAT E, WORK TC HOU,F EWER $3.D©- $5 DO ALTE:t. ORCABiN.,.)o�i HWY,OR G7.WIDENING ZZ q OR ViSP,0SAA-FYS EM @-SI3oo No. CHARGES MOM 00 CONNECTION CHARGE FEE AUTHORIZATION FEE kT - 'ArE A 'THE HERF-'IN NAMED CON- RR" MB u P 73 E M E N 1"F F E. HAVE A ­iMi L CONTRACT WITH T,, THE EXISTING r CICIR 1 0 IN N E c ABOVE DESCRIStrr -WELLI To HE U B 1C APPROVALS CAT E INSPECT RS5 t G NATU PC SIGNED DAY 0 w N E R 12,F NEW i IOUSE SEWER CONNECT a.CDIT t jN"" BUILMNG OR'A'ORK 'MF`TIC TANK,SEE7P;PIT(S) HIERE:3Y ACKNOVVLCOGr THAT 1 HAVE READ THIS APPLICA tON AND/OR URAINFII�LD AND .,TATETHAI THE: ABOVF !S CORHKCT AND AGREE To COMPLY ---- -------- W�_ A��- COUNTY ORDINANCr,; AND STATE LAWS REGULATiNG __.12 -00�. DRYVVYLL. ❑ I n --Y CERTIFY THA7' I AM PROPM-:Y REGISTt RPO AND/CIR ,,9 T6ER-REPAIR,SEVVt:R oR FN.ED AS REQUIRED BY iO$ ANGLES COUNTY AND STATE OF sEWAGE DISPOSAL.SYSrLM C OW ER '1— -i� ------------ Al FORNIA OR 'THAT i AM T-HF: LXGA�, N, OF, AND rEND TO f�ESQ JN, c A.1-VE ROPF i4y.. IFEN-I�AL P AND OU S E S EVV E R X-5 �$ANDON I S'GNATURE "'L;ICKIILL 5E C rANKS Mail SEP.PIT(S) VALIDA'-dON ROSERT A. WOOD CK M.0 CASH SUPFRNESING MECHANiCAL ENGINE11 "Y -?6 7' iZ'�- 7.( 0- r � F,Og APPLICATION FOR PERMIT IT ,. �AE4?r? COUNTY Or LOU ANGELES DEPARTMENT or COUNTY EGINEER SEWED—SEWAGE DISPOSAL,., BUILDING ANIS SAFE'T'Y DIVISION BUILDING 4 JOHN A. LAVIB1E, County Engineer aDDREss ------ ihI�LIAM A„ JENSEk, Supt of Hu ld.ing F LOC;A.LI`FY FOR APPLICANT TO FILL IN GROSS sr. _. DESC (ION Gt°I xO _�,Cf e ...- 1 OWNER 9 _.. 83:OC.N. TP?ACl 'is a--.�'^C �_€>_ gg.-;.:fF ADDRf:SS _.__ _ __ -_ � _ __ —._—.. _._. _.. __ —_. ._.._— .tom NO pF E3 L"S'.. SIZE NOYr ON.LOT !TY TEL, NO, USE 64!L.Dif`rS DISTRICTN iROU MAP RJ 0 SK PC ( � c ADDRESS fit` $ - I _CONNECTION DATA y� ,-_ [C.N ! t DEFY" 7 �-+ F / � NO �':S� -Pct �_-� /./ 04 wk PFCi.;S rf'ATC31`t h f t•,_T_. Ey..11 `��r'fiE NIA!1 s{OI F REFERENCE/ t y;,. y '! ,r - 44eFF•d ❑ COUN'T'Y / NO. DER,,C-PIFI-ON 0-,F,,--- R-.K .FEC .. ! 5'YPF�F�iJF NFCTION � LE Nf3TF'r`ROM HOU Cr $5.00 �...: • C.�iJ Fr EI P.L. M(L. Y0 F.L. �.v SFrVCR GONtiE^',(NG 70 r` , PUBLIC SEWER @ SEPTIC TANK.SEEPAGE FIT-r5?2 .�._.... -..,... ------ _. t P.C.NO IMP NO. JO.FS-NO PITS AND/OR DF;AINFfEf..D C7 $LQ.00 pUSESATE QYE. ER LAN Nt:.T ECY{NO 'f',F(.0 fJ.K F£RM7?NO- RpAD PERMIT^'jN,y„'f. PRIVATE DISPOSAL SYSTEM @ E3.00 !t- , ___. .__ __-- __ _ ._ Z .._.. f0 dNFCT dDD '77N AL BLDG 06t AFFIDAVIT I wntwcx ens EM Ehi RECQRD KNSTR NO DATE -- WORK TO HOUSE SEWER 93.00 _—_.. O FR SEEP OW SEEPAG_. PtT._DRd.. ! _.__. ' �. ;. NFI EI_D t PXTP•t,CE:Suu{00 L'RYwEI L.,MANh)LF $.�DO '--- HWY.OR SI" WIDENING T A'—TER.R PA RUR ! U ABANDON ♦OSE E WdROY T"]la#�G/abk S$YY STEM S"')DD _ "' — '-- - .. _ }. _. �.� STATE,q'riACROACH ME NT TRIAL CHARGES' OV^NER HARCFSOYpEg S MIT .('9.EJ 111'i.e,€R.LC.�d`SlION TOTAL FSE CONNECTION CHARGE.FEE HAVV A'7' 'CHIS DATE: A CONTRACT WITH THC THEREIN NAMED CON. REIMBURSEMENT_FEE- TRACTOR TCS CC Ff cCl THE ABOVE DESCRjo1ED EXISTING DWELLING - - TO THE pLSI_I C' SSEWER, - DATE `tN PECYCR S SIGNATURE.. SIGNED THi ..._ DAY f>F._-- 4„ __..APPR®VALS _ I OWNER OR .. NEW HOU SEWER f OWNERS AGE. _._.N7__ __ _--_. ONNE_Cf ADDITIONAL DU ILOIt G OR WON A_DD.RES EP'i'fr_YANK,SEEP FIT(S) I IHLRESY ACKNOWLE CSE 7'HA.T I HAVE READ THI APPLICATION AJ �Of-DRAfNFiELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY I- WITH ALL. COUNTY OR IP ANCES AND STATE; LAYS REGULA'TfNG PLU MQING .AND SEV1ERw ESSPOOL El DRYWELL i HF 7BY CERT -e 'r ,1 f .AM PROPERLY REGISTERED ANC/OR ALTER,REPAIR,SEWER OR _— "4 TOR R _U,REU OR THAT 1 AM P"ri L..Os. %.N.GLES COUNTY AND STATE_' OF SEWAGE DISPOSAL;;STEPS RESIDE !N HE ABJVEDESCRIBED rtE4! FN'IA.L PROPERTYN6 TO DISCONN '--- --' - —'f '—'r ----- - ----- ---- AL-IF C} UTA F LEGAL O" NER OF AND INT Ec_T PLUG AND f ABANDON HOUSE SEWER Sf GNAYURE' C '{' u.° pp J LACKFILL SEPTIC TANKS' 17 OF PEftfw IT7EE ,4 w. :•".-#+ -�._,. ^:-..�._. ..[EP,.PfY(S.) L1 C..:SSPO QLS nI —, VALIDATION ROBERT A. WOOD SL)PERVISIt,4 MECHANICAL ENGINEER CK.`/ M.O CASH