HomeMy Public PortalAbout9824 VAL ST_Sewer__ DEPA rA ENT OF OOUNTY ENGDERM SEWER—SEWAGE DISPOSAL _70
DIVISION OF-BURMING AND SAFETY PERMIT APPLICATION L
OODNTY OF LOS ANOELE$
WILLIAM J. FOX. COUNTY ENGINEER WILDING
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OWNER /
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ADDRESS USE 20 E OOCUP� I SK ( PG
CITY TEL NO
CONTRACTOR �� o/C /(i'(U
CO.IMP NO 332- /
ADDRESS O��� L JOB NO
CITY A)c_?e_0I1_p_/4tTKLNO f
TRUNK PERMIT NO
ATE
REGISTRATION NO G COUNTY ROAD PERMIT NO
LEGAL[GAL
DESCRIPTION LOT NO 44 STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT /- INDUSTRIAL
WASTE APPROVAL
812E OF LOT NO OF BLOGB
O OW ON LOT CHARGES
USE OF /
BUILDINGS W CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICBEWER 8 ! 860 RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLOB OR E%CEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR AIR EXISTING ' NO DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AMD OR DISPOSAL SYSTEM 1 00 CONNECTIO DATA
PITS AND/OR DRAT NFIELD OR 200 STATION O� DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 7 NHOL1 REFERENCE
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TYPE OF OO VECTION LENGTH FROi 1
OWNERS FERMrt s i 00 -- Y L TO P L lJ
AUTHORIZATION TOTAL FEE ��
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCH ED EXISTING APPROVALS INSPECTOR'S GNATURE DATE
DWELLING TO T112�PUBLIC SEWER
SIGNED THIS—_,.DAY OF_ 1 NEW HOUSE SEWER
OWNER ORC/OCONNECT ADDITIONAL
OWNERS AGE T BUILDINGORWORK
_ � ] _ SEPTIC TAN SEEP.PIT(S)
ADDRESS - AND OR DRA NFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL ORYWELLO
CATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE
TO COMPLY WITH ALL UOUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLU YBING AND BEW ERB SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED DISCONNECT PLUS AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALI MIA OR THAT I AN THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOV CRIBE DEN AL HOP BACKFILL IIEPTICTANKS
SIGNATURE SEEP PIT(S)0 CESSPOOLS 7-.2,0,.5
OF PERU ITTE
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T/n1iEEE 6.. APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER-SEWAGE DISP SAL
DEPARTMENT T OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDInG
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MAIL TRACT ADDRESSNO OF SLOGS
F LOT NOW ON LOT CITY TEL NO
GS DISTRICT NO I GROUPI MAP P {[D pY
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CONTRACTOR
ADDRESS CONNECTION DATA
CI TEL NO STATION DEPTH
TnTQ MANHOLE REFERENCE UPPER
RE°I6TRATIO O HTY LOWER
No DESCRIPTION OF WORK FEE TYP¢OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB P L TO P L
PUBLIC SEWEA 49 iS 00 PC NO
/ PTICTANK SEEPAG[PIT OR CO IMP NO U00 NO
PITS A NO/OR GRAINFIELD B SIG.
HOUSE/EWER CONNECTING TO TRUNK P ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM Q $a OO
CONNECT ADDITIONAL SLOG 00 AFFIDAVIT WMVMI rur YT R[CORp STII j10 DATE
WORK TO HOU/[{EWER O 1300 S
OVERFLOW SEEPAGE PIT GRAINFIELD
[XTH CESSPOOL DRYWELL MANHOLE• $8 OO
ALT" REPAIR OR ABANDONHOUSENWY OR BY WIDENING
SEWER OR DISPOSAL SYSTEM S300 STATE ENCROACHMENT
P RMIT NO
ND
WASTE APPROV
HARD"
OWNERS PERMIT s z DD
AUTHORIZATION TOTAL FEF CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVAL$
TO THE PUBLIC S[WCR DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 1D_
OWNER OR NEW HOUSE SEWER
OW N[RS AGENT_
CONNECT ADDITIONAL
WORK ADDRESS BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
1 HERESY ACKNOWLEDGE THAT I HAVE ROAD THI/ APPLICATION Aryp/OR p AINFIELD
AND BTATC THAT THE ABOVE I/ CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATINO
PLUMBING AND SEWERS CESSPOOL Cl DRYWELL ❑
1 HERESY CERTIFY THAT I AM PROPERLY REGISTERED AND�OR ALTER REPAIR SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LE L OWNER OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN T OV[ GESC IS
CBID[NT.AL PROPERTY
AMNpON HOUSE G AND
SIGNATURE ❑
OF PERM BACKFILL SEPTIC TANK/
S[CP PIT IB) ❑ CESSPOOL°
ci VALIDA•I•ION-U ROBERT A WOOD
CK w O SUPERVISING MECHANICAL ENGINEER
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LQ7099NOV 191 0 D 5.00- a
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COUNTY OF LOS ANGELES TEMPLE CITY d 0508SEWER PERN'lT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS �SE10508 9905240001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE (626) 285-0488 EXT: jj
LEGAL ID SEWER / SEPTIC S
ST�,
ADDRESS
TR 16867 LT 4 EXIST OCC GRP 98241VAL7
BLDGS. NOW ON LOT TEMPj'A
XSTw
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET
ORIGINATION. TII�AS PAGE��" GRID LOCALITY TEMPLE CITY
LENGTH ML TO PL STATION DEPTH
TENANT MANHOLE REFERENCE NIPPER/LOWER
05/24/99 UT 11/20/99
COUNTY IMPROVEMENT NUMBER
OWNERWRIGHT, TOM PLAN CHECK NUMBER FINAL FINAL 11
9824 E VAL (626) 446-4545- JOB NUMBER. /
TEMPLE CITY, CA TRUNK PERMIT NUMBER /'��K -
AROADFFA PERMIT NUMBER ur LIN
WAIVDAVIT. NO REPAIR TO SEWER LINE
WAIVER NO
APPLICANT -7n--WT- EASEMENT- NO
GOLDEN BEST PLUMBING (800) 628-5553-
14349 VICTORY B RECORD INSTRUMENT NBR. RECORD DATE SPECIAL CONDITIONS
VAN NUYS, CA HIGHWAY/STREETMWIDENING�
STATE EN�D'T����'Q
` APPROVALS DATE I msF9ETM-9rffWffUWF--
GOLDEN BEST PLUMBING (800) 628-5553- / . 9CONTRACTOR � PAX
14349 VICTORY BLVD. LIC NO FEE DESCRIPTION GMT ITY 110M: AMOUNT i
VAN NUYS, CA 91401 709837 C36 /f 5
O1 PERMIT ISSWUCE2FEE r 27.75
15 ALT/REP 7E SEWER 1:00 EAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER —Tn—lIT - I TOTAL FEES 58.20 SEPTIC
gnTAWIFff
LIC N0� 1111111 AMD/OR DRAIN FIELD
SEWER MAP ALTE SEWER OR
W U B L I C WORKS SEWAGE D1=L SYSTEM
C y N ABANDON HOUSE SEWER
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SEEP PIT CESSPOOL
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REPORT ID: DPR266 ROUTE TO BS0508