HomeMy Public PortalAbout5447 WELLAND AVE_Sewer__ COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1104060001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: ISEWER / SEPTIC: SEWER I BUILDING ADDRESS: 1
ITR: 10260 IT: 20 (EXIST OCC GRP: I 5447 WELLAND AV I
I IBLDGS. NOW ON LOT: I TEMP CA 917803510 I
(ASSESSOR INFORMATION NUMBER: (CONNECTION TYPE: I NEAREST CROSS STREET: DAINES I
18573-016-040 (ORIGINATION: I THOMAS PAGE: 597 GRID: D3 LOCALITY: TEMPLE CITY, Cl
(LENGTH ML TO PL: STATION: DEPTH: I I
(TENANT: IMANHOLE REFERENCE: UPPER/LOWER: [ISSUED ON: PROCESSED BY:
I 1 104/06/11 SR I
ICOUNTY IMPROVEMENT NUMBER: I I
1OWNER: TEL. NO: 1PLAN CHECK NUMBER: IFI . ATE F Y: CODE: 1
IHOCCOM ROBERT A (626) 392-3801- IJOB NUMBER: I ✓i� I
15447 WELLAND AV ITRUNK PERMIT NUMBER: I \ I
ITEMP 917803510 IROAD PERMIT NUMBER: IDES RIPTION OF WORK [
IAFFADAVIT: NO ISEWER REPAIR CLEAN OUT INSTALL 1
IWAIVER: NO 1 I
(APPLICANT: TEL. NO: (EASEMENT: NO I 1
1LANG, VINCENT (626) 858-9284-
475 ARROW HWY IRECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS: I
1 AZUSA, CA 91702 [HIGHWAY/STREET WIDENING: 1 I[STATE ENCROACHMENT PERMIT NUMBER: I
ICONTRACTOR: TEL. NO: I FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE I
1 A R S RESCUE ROOTER (626) 858-9284- 1 1 I
475 E. ARROW KWY LIC. NO [FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:INEW HOUSE SEWER I I I
(AZUSA, CA 91702 765155 C36 I I- I I I
1 101 PERMIT ISSUANCE FEE 27.80 ICONNECT ADDITIONAL I 1 I
1 115 ALT/REP HOUSE SEWER 1.00 EAC 30.40 IBUILDING OR WORK I 1 I
1ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.20 1 I 1 1
I - I ISEPTIC TANK, SEEPAGE PITI I I
LIC. NO: I (AND/OR DRAIN FIELD I I I
1 I 1DRYWELL
1 SEWER MAP BOOK: PAGE: I IALTER, REPAIR, SEWER OR I I I
ISEWAGE DISPOSAL SYSTEM I 1 I
IDISCONNECT PLUG AND I I 1
I (ABANDON HOUSE SEWER 1 1 I
I I (BACKFILL SEPTIC TANKS
I 1
IMP. PIT _ CESSPOOL
I [ 1GRAYWATER SYSTEM 1 I
I I I o I_ I
,II
I I I I 1
I I I I I
I I I I I I
I I I I i I
I I I I I I
I I I I i I
1REPORT ID: DPR266 ROUTE TO BS0508 1 1 I I
y
`715A6420SDS �° APPLICATION ,POR PERMIT
COUNTY OF LOS ANGELES SEWER®SElIVA.GE DISPOSAL
BUILDING
COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
,�{ h� � � �{�
IO-.N A. LAMBIE, County Engineer
� I
WLLLIAM A, JENSEN, 5up't ®f Building
FOR APPLICANT TO FILL IN
r -
LECA ,
T f
C.SCRI TION LOT NO -r OWNER
MAIL - ...
BLOCK TRACT - ADDRESS
i
---- - -__-- - _ - NO. OF 6tDOS.
SIZE. OF LOT WOW ON LOT CITY TEL. NO.
USC OF
BUN'DiNcs DISTRICT NO. GROUP MAP PROCESSED BY
ON-TRACTOR -
2s
AaDR .,-'ye-�� },Y '✓' ' y --- -- ---CONNECTION DATA -- --
,9 " -r STATION! DEPTH
CIT. ,y,/ +"fiwr." TEL NO -y �r
TATE MANHOLE REFERENCE•....
REGISTRATION NO. f f'04i NTY - LOWER- - — ---- a.
NO. DESCRIPTION OF WORK rEE
-__ _ TYPE OF CONNECTION S.E�N t>TW FROM14
ULI SC WER CONNECTING;•TO Y
PCURB P L. M:L TO P L-.
PUB !C S Vl.:R @ $.`=,00 '.. P.C.NO
_-.—..- --_. _ ,r��
SEEPAGE
O
SEP �.TA NK, RAHNG£. .D OR CO. IMP NO OB NO. -- -
P TS AND OF URRINrI EL.D $.r,,OD - .. __ __ __—,..__ _._. _.___
HOLSi SG WERC CONNECTING TO
PRIVATE LiSPOS•+, TR Nfc�stjf+l lrY;�O s ROAD PERMIT NO. -
NNtr; AD.JI'fiQAA L_BLDG OR __ i AF�FIDA Vf"T ! wA!vPR_ EAS[M4N ' RE CORD.INSTR NO. i DATE ---
WORK TO HOUSE.SEWER $3.00 -"'
en
LXTN C ESSP07L,DRYWELL,.tT NHOLE�' $5.00
__.. _. .. HWY. OR ST.Wi DEN NG
L
AL.R HEPS Ft OR ABA NDUN HOUSE
SEWER OR D,SPOa-'AL SYSTEM @ $3..00
._
---� STATE ENCROACHMENT
_-- PERMIT NO.
i
INDUSTRIAL
WASTE APPROVAL
O YM NEE PERMIT Z. QQ CHARGES
_._._ __..__.. -._.. CONNECTION CHARGE FEE
AUTHORIZATION TOTAL E -_--
?
HAVE AT THIS DATE A CONTRACT WITH THE: HEREIN NAMED CAN- REIMBURSEMENTEt-
TRACTCJR YO CONF7ECT' THE ATi UYE DESC R!BED EXBST'NG DWE LL!N'G __ ._p—
TO T'HE PUBLIC SEWER. APPROVALS DATE INSPECT'OR'$SIGNATURE
S!Gti.ED THIS--DAY OF 13� ---------'-.._-------------------
� I
OWNER OR NEW HOUSE SEWER
OWNERS AliEGv"G _-_- CONNECT ADDITIONAL,_—_._._.__;
BUILDING OR WORK
1
SEPTIC YANK.SEEP,P17(5)
1 PERC'r3Y ACKNOWLEDGE THAT I HAVE P.FAD THIS APPLICATION AND/OR QRAINFIE LD
AND STATE -THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH, ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS, CESSPOOL f,:] DRYWCLL }I
--...—
i HEREBY C RT1Pv THAT I AM PROPERLY REGISTERED AND'OR ALYER,RE PAIR,SEWER OR
LICENSED AS REQUIRED BY LOS A14GLFS COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CA LIFOR4dIA 0R 'TWAT. i AM THE a.EGAL OWNER OF; AND INTEND TO '—`—. ...—...--`-_. -�
LTISCON NFT' ANDCPLUG AND
RESiD IN,. THE ABOVE DESCRIBED RZSIDENl IAi- PROPERTY. j
ABANDON HOUSE FEWER
1-
OF PERMITTEE ..- '� � _ BACKFILL SEPTIC TANKS
SEEP,r T4S) ❑ CESSPOOLS II
'VALIDATION ROBERT A. WOOD
,j SUPERVISING MECHANICAL.. ENGINEER
C.K. ✓ M.O. CASH
Y
tlb kSTv"�A� ir� 'S��i aiS� ,
E86
8 X8.59 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL'
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FADDRESSING
IOHN1 IL LAMBIE, County Engineer CASSATT D. GRIFFIN, Supt of Building ITY `ESTFOR APPLICANT TO FILL IN ST.
LEGAL
DESCRIPTION LOT NO, OWNER - -
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOTJBITA
CITY .TEL. NO
USE OF
BUILDINGS DISTRICT NO. GROUP - MAP PROCESSED BY
BK FG
CONTRACTOR" ,_..
ADDRESS CONNECTION DATA
CITY uY"4�TEL.NO, STATION"" DEPTH
MANHOLE REFERENCE 'EGISTRA73ON N0. - LOWER'N0. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @-.$30TYPE OF Sn#NEC710N LENGTH FROMSEPTIC TANK,SEEPAGE PIT ORY, �-CURB P.L. M.L.TO P.L,PITS AND/ORDRAINFIELD @ 58.0OVERFLOW SEEPAGE PIT,DRAINFIELD
EX7'N..CESSPOOL, DRYWELL @ $2.0HOUSE SEWER CONNECTING TO -- P.C.NO.
PRIVATE61SPOSALSYSTEM @ $1.000.CMP.NO.; JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER $1.00
TRUNK PERMIT NO. ROAD PERMIT NOc` -
@
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT '
SEWER OR DISPOSAL SYSTEM - @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE T REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HERE114 AMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE fNSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER,
SIGNED THIS DAY OF 19._ NEW HOUSE SEWER y
OWNER OR CONNECT ADDITIONAL
OWNERSAGENT— BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL U. DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STA7€ LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONNECT
D
CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVEHOUSE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS- ❑
y SEEP.PIT(S) ❑
SIGNATURE CESSPOOLS
-y'"�
OF PER.MITTE
VALIDATION ROBERT A. WOOD
q' CIC. J N.0. CASH SUPERVISING MECHANICAL, ENGINEER,
ul O U , SEP 3 .1 0 D 7L -
z