HomeMy Public PortalAbout9059 WOOLLEY ST_Sewer__ APPLICATION FOR PERMIT
DISxaN I
P,Z�BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
nt of County Engineer
County of Los Angeles BUILDING
JOHN A. LAIMBIE, COUNTY Er-3GINFER ADDRESS A E-,y
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
ti;-, C, i 7-V
rNEAREST
FOR APPLICANT TO FILL IN CROSS ST. IVA , A
LEGAL
DESCRIPTION
LOT NO. OWN
Al
BLOCK TRACTKf/, ADDRESS
-/
NO. 01 BLDCS.
SIZE OF LO NOW ON LOT CITY rta,2 0 AA;7 61-L TEL. NO.
USE OF
BUiLDTNGSDISTRIC NO, CROUP I MAP
-A--At BK PSP r
CONTRACTOR
'4L
ADDRESSCONNE TION DATA
<
7
STATION DEPTH
CITY TEL. NO,,/,
MANHOLE REFERENCE UPPER'
C1 STATE LOWER
REGISTRATION NO.
47 0
COUNTY
0
DESCRIPTION OF ORK (EE
TYPE OF CQNNFCTIOt ,,_ I.E NGT H FROM
HOUSE SEWER CONNECTING TO
PUB Y. CURB PL,' M.L. TO t�L.
LIC SEWER @ ------
SEPTIC TANK,SEEPAGE-IT OR
1_ PITS AND/OR DRAINFILLD q. $8.00,
OVERFLOW SEEPAGE PIT,DRAINFIELD '00 10, Imp� No. P. C, N0.
EXTN-CESSPOGL,DRYWELL,� ((r, $ JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM. QIj $i.00 TRUNK PERMIT No. ROAD PERMIT NO,
1 CONNECT ADC .ZONAL OR
3 ATE ENCROACHMENT
WORK TO HOUSES EWEN� T PERMIT NO.
-
--
ALTER, -E-FA-!R-0-RAB.X b<W-st
I-N D-U-S-T R-I-A L-
SEWER OR DISPOSAL SYSTEM
APPROVAL
WASTE
CH ARLES
CONNECTION CHARGE FEE
OWNER'S PERMIT 0-0
I REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE--
Z11
I RZ
I 14AVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
APPROVALS DATE NSPECTOR'S 5IGNATUE
TRACTOR TO CONNECT.-THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED Ti I
DAY OF. I9 CONNECT ADDITIONAL
OWNER OR2UILDING OR
OV'�'NERS AGENT Uel"-I'le/
SEPTIC TANK,SEEP,PIT(S)
ADDRESS 4ND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE FAD THIS APPLICATION CESSPOOL[I DRYWELL El
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALI. COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
PLUMBING AND SEWERS. 9EWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY'REGISTERED AND/OR
LICENSED As REOUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I THE LEGAL OWNER OF THE ABOVE -ABANDON- ---I-1-OUSESEWER
DESCRIBED RESIDENiAl, o"PERTY, BACKFILL SEPT�C TANKS ILI
SIGNATURE SEEP.Pig Sj I.__CESSPOOL5I
OF PERMITTEE
JOHN.A. LAMB!g,r-OUNTY ENGINEER VALIDATION--- ROBERT A. WOOD, CHIEF PLE3G. INSPECTOR
(-jA 5
U
5 C)
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0304070004
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: l9w 7 SO= .
ON FILE EXIST OCC GRP:. G 9059 WOOLLEY ST
BLDGS. NOW ON LOT: TEMP CA 917801348
ASSESSOR OR ER: CONNECTION TYPE: NEAREST CROSS STREET: SULTANA
5382-019-028 ORIGINATION: THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: --PROCESSEDBY: .
04/07/03 JK 10/04/03 .
COUNTY IMPROVEMENT NUMBER:
OWNER: EL. NO: PLAN CHECK NUMBER: FINAL gATE FINAL CODE:
PHUNG;SAM - JOB NUMBER: kmDESCRIPTION
3211MINNESOTA ST TRUNK PERMIT NUMBER:
LA CA 90031 ROAD PERMIT NUMBER: OF WORK
AFFADAVIT: NO CONNECT SFR TO PUBLIC SEWER
WAIVER: NO
PP EASEMENT: NO
SAME AS OWNER -
RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
SAME AS OWNER -
LIC. NO FEE DESCRIPTION: QUANTITY: LION: AMOUNT: NEW HOUSE
01 PERMIT ISSUANCE FEE 27.75 CON ECT ADDI IONAL
03 CONN TO PUBLIC SEWER 1.00 CON 46.95 BUILDING OR WORK
ARCHITECT OR ENGINEER: 0: TOTAL FEES 74.70
NGUYEN, FRANK (626) 960-8078- SEPTIC TANK, SEEPAGE
1208 MAYLAND AVE LIC. NO: AND/OR DRAIN FIELD
VALINDA CA 91746 NONE
WELL
SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFIlL SEPTIC A S _
SEEP. PIT CESSPOOL
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO BS0508