HomeMy Public PortalAbout6262 TEMPLE CITY BLVD_Sewer__ 7�s:�o'° APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL LJ
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESS 2 Z OSEYYI�I�rV �•
JOHN A LAMBIE COUNTY ENGINEER
COLEMAN W JENKINS SUPT OF BUILDING �`yH�pLLs L
LOCALITY
FOR NT TO FILL IN NEAREST L�
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LICENSE NO �A�LO( T C A/a (ice 1�
No I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH OM
OU{[{EWER CONNECTING TO Y CURB P L M L TO L
PUBLIC SMKR O PC MO
SEPTIC FANK SEEPAGE PIT ON
PITS AND/OR DRA INFIELD O SIO DO CO IMP MO JOB MO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO Y
PRIVATE DISPOSAL SYSTEM O ES oo CL
CONN[CTADDITI...L SLD. OR AFFIDAVIT uT[[ f1[DHRF RECORD INST1 NO DATE O
WORK TO HROUSE aCW[ O t600 (f
OVERFLOW SEEPAGE PIT DRAINFIELD
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ALTER REPAIR OR^SAN ON NOU{C
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APROVAL �Z��JZ N
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I HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMED CDN REIMBURSEMENT FE[
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWLLLINO APPBOVA�
TO THE PUBLIC SEWER R DAT[ IN21ECTORI SIGNATURE
SIGNED THIS DAY OF 19_ `o
OWNER OR NEW HOUGE SEWER i(J
OWNERS AO[MT
CONNECT A NAL
ADDRESS BUILDING on WOR
woRK
PEPTIC TANK /CCP PIT(S)
I HERESY ACKNOWLEDGE ABO THAT I HAVE READ THIS APPLICATIOtAMMOOK
AND/OR GRAINFIELD
ANp STAT[ THAT THE ABOVE I{ CORRECT AND AGREE E COMPL
WITH ALL C Y ORDIMANCP AND STATE LA WB REGULATING LATIN
PLUMBING ^ [Rf POOL ❑ pRYWILL ❑
1 HEREBY C I Y THAT I AM PROPERLY R! ISTE AMD/OER REPAIR S[WEROR
LICENSED A{ R RCD BY LOS ANGLES COU A D STAT( OAGE DISPOSAL SYSTEM
CALI FOIINI AM THE OW R INTEND T
RESIDE I TX[ A CSCR(• TIAL p [RTY ONNECT PLUG AND
HOUSE SEWER
SI.NAT COPPL MTTT[[ I FILL SEPTIC TANKS PIT IBI LI CESSPOOLS
r1. 7
ATION JACK R ALLEN
O CASH SUPERVISING MECHANICAL ENGINEER
2 5 21 1 0 o 6.00- 0
• _ COUNTY OF LOS ANGELES TEMPLE CITY @ 0508 ERM4T
DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SE"0508-98102DO033
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (818) 285-0488 EXT
LEGAL ID SEWER / SEPTIC S BUILDING ADDRESS
TR- 5904 LT 89 BL 001 EXIST OCC GRP i462621A1A)IRDSERKD SL
BLDGS NOW ON LOT TEMP-CA 917801542
ASSESSOR INFORMATION NLE48ER CONNECTION TYPE NEAREST CROSS STREET LONGDEN
5384-005-002 ORIGINATION THOMAS PAGE 596 GRID H2 LOCALITY TEMPLE CITY
LENGTH ML TO PL STATION DEPTH
MANHOLE REFERENCE UPPER/LOWER ISSUED ON PROCESSED BY EPTFn'UW
WATERMILL EXPRESS 10/29/98 UT 10/29/99
COUNTY IMPROVEMENT NUMBER
OWNER PLAN CHECK NUMBER FINAL DATE /J
SMALDINO LOUIS P DOROTHY A - JOB NUMBER
13583 WHITTIER BC TRUNK PERMIT NUMBER "/ 7
WHIT 906051935 ROAD PERMIT NUMBER 6E$mPiiON3F WOR
AFFADAVIT. NO CONNECTJWATER!VENDING KIOSK-TOlK -SEVER
WAIVER NO
APPLICANT TEL. NO EASEMENT NO
JOE GARRETT (949) 222-0058-
4500 CAMPUS DRIVE RECORD INSTRUMENT MBR.-
BR. RECORD DATE SPECIAL CONDITIONS
NEWPORT BEACH, CA HIGHWAY/STREET.WIDENIMG.
STATE ENCROACHMENT PF7W[TENIMBER:
CONTRACTOR TEC--WF- Fttu FAID&,-% APPROVALS DATE INSPECTOR
G 8 J DEVELOPMENT (520) 670-9336- //�/ �A-
7329 S PISTOL HILL ROAD LIC NO FEE DESCRIPTION: QUANTITY LION AMOUNT NEW HOUSE SEWER
VAIL, A2 746522 B /� //
Ot PERMIT(,ISSUANCE�FEE 27 75 CONNECT ADDITIONAL
19 CONN ADDTNL BLDG(S) 1.00 EAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER. TEE-RU-- TOTAL FEES 58 20
DEBCO ENGINEERING (307) 637-4022-/ - SEEPAGrM
P 0 BOX 884 LIC. NO /1 111 illi AND/OR DRAIN FIELD
CDRYWELL
HEYENNE, WY NONE 1'r
REPAIR, 9MEff-W-
PUBLIC WORKS SEWAGE DISPOSAL SYSTEM
MMECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL 9EPTrFTMi[9---
SEEP PIT _ CESSPOOL _
�tGRAYWATER SYSTEM
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REPORT ID DPR266 ROUTE TO BS0508