HomeMy Public PortalAbout6358 TRELAWNEY AVE_Sewer__ CEaOe APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING q r
JOHN A LANIBIF C..Gty IGgweer AOORESS 7/J J r� Q4{/'� C.
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DESCRIPTION LOT NO ' rJ OWNER I S O
MAIL
BLOCK TRACT 2 ADDRESS
NO OF SLOBS /
SIZE OF LOT f NOW ON LOT CITY TEL NO �I
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ADDRESS y.[o CONNECTION DATA
CITY .(. / TEL NO `(/ STATION 3 r DEPTH
NIOCf MSE, 70/� CLAS SSE
MAMXOLE REFERENCE / A�
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No DESCRIPTION OF WORK FC[ TYPO Oi ION LENGTH FR L,
HOUSE SEWER CONNECTING TO O Y CURB PL ML TOPL `/ Y
PUBLIC SEWER L P $ ! 00 PC NO d
PIT! AHO/OR GRAINFIELD CT §10 00
CO IMP NO JOB NO O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO V
PRIVATE DISPOSAL SYSTEM R § 3 00 IS
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CONNECT HOUSE
SEW BL R AFFIDAVIT �11T[[ rBrr Rrlll RECORD IM6TR NO ATQ O
WORN TO 7VXTW SEWER ^ § 3 OO
HOUSE_0R ABANDON
SEWER OR DISPOSAL SYSTEM B § 9 OO
HWY OR 6T WIDENING 1
E2TN CESSPOOL MANHOLE R § ! 00 H
STATEENCROACHMENTNCROACNMENT Z
PERCOLATION TEST f f S OG PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNERrS CHARGES
T.3,LLE J PERMIT f 2 00
AUTHORIZATION TOTAL FEE CONNECTION CHARD[F[[
I HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN N MED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINO DWELLING
TO TH[ PUELIC 6C APPROVALS DAT[ INsptc RBHIOXATURC
SIGNED THIS DAY OF 1B
OWNER A NEW CONNECT
SEWER
OWNER OR NT �L.J.�-� �Z
CONNECT ADDITIONAL
ADDRESS SEPTIC NO OR WORK
I HEREBY ACKNOWLEDGE THAT I HAVE READ T415 APPLICATION SEPTICTA NK BEER PIT(S)
AND STAT[ THAT THE ABOVE IB CORRECT AND AGREE TO COMPLY ANO/OR DRAIXPItLD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
FLUMOIND AND SEWER$ CESSPOOL ❑ DRYWELL Cl
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED A8 R[OUIRED BY LOS ANGLES COUNTY AND STAT[ OF SEWAGE D16POSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN
THE ABOVE DESCRIBED RESIDENTIAL P CRTY
ABANDON HOUSE SEWER
HIOF PER C BACKFILL SEPTIC TANKS
OF PERMITTEE SEEP PIT(S) ❑ CESSPO❑OLI
VALIDATION
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• •CDUNTY'OF LOS ANGELES TEMPLE CITY # 0508 9EWERPERMIiT„;
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE`O508"9901110009
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT-
LEGAL ID SEWER / SEPTIC: X BUILDINGADDRESS
TR 14263 LT 7 EXIST OCC GRP i6358BTRELAWNEY+AVS
BLDGS NOW ON LOT TEMP-CA 917801311
ASSESSOR INFORMATION NUMBER CONNECTION TYPE NEAREST CROSS STREET LEMON
5382-022-035 ORIGINATION THOMAS PAGE 596 GRID J2 LOCALITY TEMPLE CITY
LENGTH ML TO PL: STATION DEPTH
TENANT MANHOLE REFERENCE UPPER/LOWER ISSUED ON PROCESSED BY El(PIRES ON
01/13/99 UT 01/13/00
COUNTY IMPROVEMENT NUMBER
OWNER PLAN CHECK NUMBER FINAL DATE FINAL BY CODE
HUING DOUG 0 (626) 285-5033- JOB NUMBER
6358 TRELAMIEY AV TRUNK PERMIT NUMBER
TEMP 917801311 RNID PERMIT NUMBER DESCRIPTION OF WORK
AFFADAVIT NO CONNECT-GUEST HOUSE_TO-SEWER-SYSTEM
WAIVER NO _
APPLICANT TEL NO EASEMENT NO
SAME AS OWNER -
RECORD INSTRUMENT NBR: RECORD DATE SPECIAL CONDITIONS
H IGH WAY/STREET�WI DEM IMO•��
STATE ENCROAClMWN ;P9 TSMU®ER.
,-,Op- o%w - n.i
CONTRACTOR TEL NOoo
APPROVALS DATE I NSFnTM-9rffWMUT--
SAME AS OWNER LIC NO SEE D��IPSON i/'� QUANTITY
AMOUNT. HOUSE SEWER
01 PERMIT ISSUANCE FEE 27 75
1119 CONN'ADDTNL_BLDO(S) 1 00 EAC 30 45 BUILDING OR WORK
ARCHITECT OR ENGINEER TEL NO // TOTAL FEES 58 20
LIC NO� 111111 AND/OR DRAIN FIELD
URYWELL
SEWER RAP BOOK: PAGE: ALTER REPAIR SEWER OR
JIUBLIC WORKS SEWAGE DISPOSAL SYSTEM
ABANDON HOUSE SEWER
swt
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. _
A Q �Py SEEP PIT _ CESSPOOL _
GRAYWATER SYSTEM
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REPORT ID DPR266 ROUTE TO BS0508