HomeMy Public PortalAbout9160 WOOLLEY ST_Sewer__ I "ZOUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1112130003
` BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
(LEGAL ID: ISEWER / SEPTIC: SEWER I BUILDING ADDRESS: 1
ITR: 12115 LT: 18 BL: .001 (EXIST OCC GRP: 1 9160 WOOLLEY ST 1
IBLDGS. NOW ON LOT: I TEMP CA 917801349 I
(ASSESSOR INFORMATION NUMBER: (CONNECTION TYPE: I NEAREST CROSS STREET: I
15382-023-010 (ORIGINATION: I THOMAS PAGE: 596 GRID: H2 LOCALITY: TEMPLE CITY, Cl
I ILENGTH ML TO PL: STATION: DEPTH:
(
(TENANT: IMANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: 1
1 1 112/13/11 SR 1
ICOUNTY IMPROVEMENT NUMBER:
(OWNER: TEL. NO: IPLAN CHECK NUMBER: 1FINAL DATE FINAL BY: CODE: I
IGILLETTE GERALD R (626) 287-5508- IJOB NUMBER:
19160 WOOLLEY ST ITRUNK PERMIT NUMBER:
ITEMP 917801349 IROAD PERMIT NUMBER: IDESCRIPTION OF WORK [
IAFFADAVIT: NO ISEWER SPOT REPAIR ON MAIN LINE 1
IWAIVER: NO
(APPLICANT: TEL. NO: (EASEMENT: NO I I
ITODHUNTER, STACY (626) 858-9284- 1I 1
1475 E. ARROW HWY 1RECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS: 1
IAZUSA, CA 91702 (HIGHWAY/STREET WIDENING: 1 1
ISTATE ENCROACHMENT PERMIT NUMBER: I I
ICONTRACTOR: TEL. NO: ' FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE 1
IRESCUE ROOTER (626) 858-9284- I 1 1
1475 E ARROW HWY LIC. NO [FEE DESCRIPTION: QUANTITY: UOM: AMOUNT:INEW HOUSE SEWER I I I
IAZUSA CA 91702 765155 C42 *1 1 I 1 [
[ 101 PERMIT ISSUANCE FEE 27.80 ICONNECT ADDITIONAL I I 1
1 103 CONN TO PUBLIC SEWER 1.00 CON 47.00 IBUILDING OR WORK I [
(ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 74.80 1 1 I 1
1 - I ISEPTIC TANK, SEEPAGE PITT I 1
1 LIC. NO: I (AND/OR DRAIN FIELD I I I
DRYWELL
SEWER MAP BOOK: PAGE: ( (ALTER, REPAIR, SEWER OR [ I [
1 I ISEWAGE DISPOSAL SYSTEM I I I
IDISCONNECT PLUG AND
1 1 (ABANDON HOUSE SEWER I I I
[ 1 IBACKFILL SEPTIC TANKS
1 I 1SEEP. PIT _ CESSPOOL
1GRAYWATER SYSTEM [ 1
kh Lu � I3r-.diI
I I I I I I
I I I I I I
I I I
1 1• ADDITIONAL DATA ON FILE 1 1 1 1
I I I I
IREPORT ID: DPR266 ROUTE TO BS0508 I 1 I 1
I 1 I I I I
D
C.&E-663 12-54APPLICA�hON Ft5R PERMIT
C.a -6
DIVISION OF BUILDING AND SAFM SEWER-SEWAGE DISPOSAL
Depariment of County Engineer
County of Los Angeles BUILD N G
WM.J. FOX, COUNTY ENGINEER --
CASSATT D.GRIFFIN.SUP'T of BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST -
CROSS ST;
LEGAL i T,;.:.%
DESCRIPTION LOT N0. .0IN,rR
BLOCK TRACT d �JJ ADDRESS ---
3
NO.OF BLDGS.
SIZE OF LOT r G,- al �` lY f NOW ON LOT �. - CITY TEL. NO.
USE OF -
BUILDINGS DISTRICT NO. - GROUP MAP
CONTRACTOR BK PG
ADDRESS CONNECTION DATA
C1➢Y_-_W.-_.,__��.._.y. -- TEL. NO. _-- STATION '-�). T�->.> + DEPTH. '
[]
STATEW x- MANHOLE REFERENCE
REGISTRATION.NO. W COUNTY . L,d'' �r .:.= � S �L.OWER_
--- TYPE OF COtBNECTIOwCLENGTH FR041
NO. j DESCRIPTION OF WORK FEE _Y. CURB M,L.TO P.L
��. HOUSE SEWER CONNECTING TO
PUBLIC SEWER $ 3.50
HOUSE SEWER CONNECTING TO ( ��
PRIVATE DISPOSAL SYSTEM 1,00
CONNECT ADDITIONAL BLDG. OR ( r; CO. IMP. No. s z JOB, NO,
I WORK TO HOUSE SEWER_ _
j ALTER OR REPAIR EXISTING -
_ SEWER_OR DISPOSAL SYSTEM 1.00 i I{I TRUNK PERMIT NO. �-'' ROAD PERMIT NO. _ --
-! D15 CONNECT AND ABANDON SEWER I� STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM _ 1.00 _ PERMIT f10. �
+.� SEPTIC TANK SEEPAGE PIT OR "�`--`
PITS AND/OR DRAINFIELD2.00 ( INDUSTRIAL
CESSPOOL-DRYWELL _ WASTE APPROVAL
...SPECIAL 'N`DITIONS ONLY 2.00
_..—� .—..CO .. CHARGES
PERMIT
CHARGE FEE`
O�tawwS pER --�� 11 00
AUTHORIZATION TOTAL FEE + 1,, —, REIMBURSEMENT FEE — - -
1 HAVE THTS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS DATE I11 PECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER - - — — — —
- —DAY OF--—-----I9---
�._.--_?5�:_ NEW HOUSE SEWER
SIGNED THIS ) W
OWNER OR CONNECT ADDITIONAL
OWNERS AGENTBUILDING OR WORK
—,..._ � - - •- -
SEPTIC TANK, SEEP, PITS)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL El DRYWELL 0
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING - ALTER, REPAIR.SEWER OR
PLUMBING AND SEWERS. SF.W_A_G_E DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR 'THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PFOPERIY. BACKFILL SEPTIC TANKS C,�
SEEP.PIT(S) ❑ CE55POOL5
SIGNATURE
_._.—.---- - ---_._..
OF PERMITTEE.
WILLIAM J. FOX, COUNTY ENGINEER VAI.ID,ATION
BY BY `
DEPUTY / /fir -t:' .A DEPUTY
BY BY
DEPUTY DEPUTY