HomeMy Public PortalAbout6361-6363-6365 TEMPLE CITY BLVD_Sewer__ TELE CITY n
76A 64ED - CE608 -9/73 APPLICATION FOR PERMIT �LJI
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
6361 N. Temple Cit Bl.
LOCALITY Temple Cit
FOR APPLICANT TO FILL IN NEAREST Longden
CROCK CTT y��y�
LEGAL
DESCRIPTION LOT NO (♦ OWNER Jim Kuhn ��R 4._ ��(
MAIL
BLOCK TRACT(lv`6� ADDRESS 1705 S. &mta Anita
SIZE OF LOT NOWOOMBLOTS 3 CITY Arcadia m NO 446-7000
USE 01 Res. DISTRICT NO GROUP MAP PROCESSED SY
BUIOINGf i1t.•�7E� ry /� BK PO
CONTRACTOR S µYS O Deal Sewer Service 4•QO o 3 36
ADDRESS 29 MaseOn Ed. / CONNECTION DATA
CITY ElIIOnte TEL NO 444-2020 STATION / OP O� DEPTH ?D
LICENSE NO,STATE 128870 CLASS C L LICMANNOL[REIEII[MC[ D+ 7 f Ap LOW[
No DESCRIPTION OF WORK FES TYPEOFCONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURE P L ML TOP L
PUBLIC SEWER O $7 OL-
SEPTIC
DS PTIC TANK SEEPAGE PIT OR P C No
PITS AMD/OR DRAINIICLD O BID Go CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM $
S 00
CONNECT ADDITIONAL SLOG R AFFIDAVIT u[1[ W,N,NT R[CORO INS" NO DATE
WORK TO H OUB[SEWER O [S OO
OVERFLOW SEEPAGE PIT GRAINFIELD O
[STM CESSPOOL ORYWELL O SSW U
ALTER REPAIR ON ABANDON HOUSE HWY OR ST WIDENING
SEWER OR DISPOSAL SYSTEM Y 63M STAT[ENCROACHMENT O
MANHOLE d $7 00 PERMIT NO S
INDUSTRIAL W
1 Saddle 9_B
WASTI APPROVAL L
OwNEWS PEow j CHARGES
AUTHOHPLATION TOTAL PEE CONNECTION CHARGE F[[
I HAVE AT THIS OAT[ A CONTRACT WITH TNC X[RCIREIMSUM[M[NT F[[
TRACTOR TO CONNECT THE ABOVE DESCRIBED EKIST
TO THE PU ELIC SEWER OVALS DATE INN SSIGNATURE
SIGNED THIS DAY OF OWNER OR NEW OS R OWNERS AO[HTCONNECTADDITIONAL
ADDRESSU ILDINO OR WORN y � 7
SEPTICTANK DEEP PITIBI
1 X[R[SY ACKNOWLE00[ THAT 1 HAVE READ TLl
ATION AMD/OR DRAINFICLD
AND
STATE THAT TH[ ABOVE IS CORRECT AND AMPLY
WITH ALL COUNTY ORD.MAN AND STAT[ LTINGPLUMBING AND SEWERS CESSPOOL ❑ DRYW[LL
I HERESY CERTIFY THAT 1 AM "OPENLY REGO/OR ALTER REPAIR SEWEROR
LICENSED AS REQUIRED BY LOS ANGLES COUNTE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AY THE LEGAL OW R OFD TORESIDEIN THE ABOVE D[SCRIB[D PIBID DISCONNECT PLUG AND
SIGNATURE
ABANDON HOUSE SEWER
OF PGMfIT :ACKFILL BE IC TANKS ❑
S[[P PIT(S) CEDDPOOLS
VALIDATION cK M D CASH
3 COMPENSATION
'-'-Y � I" 2 HOLDER:, �" t 6�QJUL 3 1 '1 0 4 OA 0
LlCY NUMBER: .�8S7d
TEMPLE CITY
TDA 542q - CE804 - 9/75 APPLICATION FOR PERMIT
BOUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
A DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ,°loo�ei� 6361 N. Temple Cit Bl[
LOCALITY Temple Cit
FOR APPLICANT TO FILL IN cl.. or Longden
LEGAL
DESCRIPTION LOT NO OWNER Vim Kuhn
BLOCK TRACT I y 2LO ADDRESS 1705 S. Santa
�1AnPi/ta
SIM OP LOT NOWOONSLOTD CITT Aroadia TEL NO 446-/000
USC OF peBS p1D TRICT NO GROUP MAP Pp0 EDDCD DT
BUILDING/ !Q1 }�.^, a- c_ D[ PS/
CONTRACTOR Yi Uare 3J001�],JpQxer Service S'40 e} F 3S.'J
ADDRESS
2933 Menson Rd. /fCONNECTION DATA
CITY El Monte TEL NO 2020 STATION .. )/ pp DEPTH
STAT[ 125670 LIC CE
LICENSE NO, GLASS MANHOLE REFERENCE d"F 2s •CO LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURS P L ML TOP L
PUBLIC S[W[R Q $700 PC NO
PTIC TANK SEEPAGE PIT OR
PITS AND/OR ORA INFIELD O SI000 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO TRUNK No
NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM SE 00
CONN ECT ADDITIONAL SLOG OR AFFIDAVIT RAI[[[ [Y.N.rt R[CORp INSTR MO WT[ }.
WORK TO HOUSE SEWER C 53M G.
OVERFLOW SEEPAGE PIT GRAINFIELD
[1RN CESSPOOL DRY W[LL O [9 00
ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING (Y
S[W8R OR DISPOSAL SYSTEM O 53M STATE ENCROACHMENT Fes'
MANHOLE {7 00 PERMIT NO Ml
INDUSTRIAL y
r"7
[T�p WAST[APPROVAL Z
IMS PERMIT s 00 CHARGES
ZA17ON TOTAL PEP T CONNECTION CHANGE PEE
THIS DAT[ A CONTRACT WITH THE HE KIN MAM[D COON REIMBURSEMENT FEE
O CONNECT THE ABOVE DESCRIBED EXISTING DWELLING _Y_O�
PUBLIC SEWER ({YFin WT[ IM• SIGNATURE
HIS DAY OF 19_
NEW HOUSE SEWERENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
i[PTIC TANK S!(P PIT(6)
1 MERCSV ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AMO/OR GRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AOR[[ TO COMPLY
WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING CESSPOOL Cl DRYWILL ❑
PLUMBING AND SSW ER6
1 N[P[BY CERTIFY THAT 1 AM PROPERLY RIOIQT[R[O ANO/OR ALTER REPAIR S[W IR OR
LICENSED AS REQUIRED BY LOS ANGLES COU TY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWN[ OF D INTEND TO pISCONNECT PLUG AND
RESIDE IN THE ABOVE O CRI CO RESIDENT L CRTY ,ABANDON HOUSE SEWER
SIGNATURE
OF PLYMTTTE BACKFILL SEPTIC TANKS ❑
•1[1 BEEF PIT(S) [ICESSPGO
VALIDATION CE M 0 CASH
KERS COMPENSATTORI
_'-Y HOLDER e','�S� ,`, 3 E -5�wJUL 3 1 U U 1 8.() C)
)LICY NUMBER: 28s 7G