HomeMy Public PortalAbout4814 KAUFFMAN AVE_Sewer__ 76A 642@-CE808 -10-71 fi PP IC ii'�j II ZrOR
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COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER > -- -.,
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
LOCALITY P/ r '
-
_ NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL //
DESCRIPTION LOT NO. le OWNER
MAIL
BLOCK TRACT / ADDRESS `
NO. OF BLDGS. -
SIZE OF LOT NOW ON LOT CITY TEL. NO,_
USE OF
BUILDINGS % DISTRICT NO. GROUP MAP 0
CE55ED BY
.- BK PG
CONTRACTOR XiVj'a.le
ADDRESS e-g- ��J�CO�+NNNECTION DATA/
CITY f ,- TEL. NO. ���� / - STATION •////�J �.� DEPTH
STATE i LIC MANHOLE REFERENCE VV' L �P
LICENSE NO:. (� CLASS �. �'� d) fO.O -LOWER
NO. _DESCRIPTION OF WORK FEE TYPE OF CONNECTION�� LENGTH FROM
HOUSE SEWER CONNECTING TO l.�\ Y. CURB �p,:L��+ M.L.TO P.L. 35
PUBLIC SEWER @ $7.00 �"' Cy
SEPTIC'TANK.SEEPAGE PIT OR P.C.NO.•
CO.IMP.NO. JOB NO.
PITS AND/OR DRAINFIELD @ $10.00
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. d
PRIVATE DISPOSAL SYSTEM @ $3.00 O
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER -EASEMENT RECORD. INSTR.NO. DATE U
WORK TO HOUSE SEWER C $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD O
EXTN..CESSPOOL.DRYWELL. (0 $5.00 HWY. OR ST.WIDENING
ALTER.REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM CC $3.00 STATE ENCROACHMENT W
MANHOLE 0 $7.00 PERMIT NO. a
INDUSTRIAL h
WASTE APPROVAL z
OWNERS PERMIT s
'-. CONNECTION CHARGE FEE CHARGES
AUTHORIZATIONJ TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_ -
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP,PIT(S) _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER, REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE DESCRIBED RE:Ze-k—,
L PROPERTY. ABANDON HOUSE SEWER
SIGNATURE
OF PERMTTTEE1-�7 410 �, BACKFILL SEPTIC TANKS ❑
SEEP.PIT 15) ❑ CESSPOOLS ❑
VALIDATION M-0, CASH
3. ,i;°,,�ii 28 1 0 D. 1 5.0 0 nit
•~ , COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0303180016
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER / SEPTIC: X BUILDING ADDRESS:
TR: 31181 LT: 11 EXIST OCC GRP: 4814 KAUFFMAN AV
BLDGS. NOW ON LOT: TEMP CA 917804244
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: LOWER AZUSA
8589-019-029 ORIGINATION: THOMAS PAGE: 597 GRID: A5 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
03/18/03 JK 09/14/03
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE:
SANDHU HARGURPAL S;HARMINDER K (626) 287-9218- JOB NUMBER:
4814 KAUFFMAN AV TRUNK PERMIT NUMBER: �I o `o3
TEMP 917804244 ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO CONNECT ADDITION TO HOUSE SEWER LINE
WAIVER: NO
APPLICANT: TEL. NO: EASEMENT: NO
JAMES GUIDO (626) 914-3293-
1207 E SIERRA MADRE RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
GLENDORA 91741 HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPEC R SIGNATURE
PINE BARK CONSTRUCTION (626) 914-3293-
1207 E SIERRA MADRE LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER
GLENDORA, CA 91741 361856B DO
01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL 1
13 WORK TO HOUSE SEWER 1.00 EAC 30.45 BUILDING OR WORK "l
ARCHITECT OR ENGINEER: TEL. NO: TOTAL FEES 58.20
TRINH, BEN (626) 384-1039-
SEPTIC TANK, SEEPAGE PIT
1207 E SIERRA MADRE LIC. NO: AND/OR DRAIN FIELD
GLENDORA, CA 91741 NONE
DRYWELL
SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS _
SEEP. PIT CESSPOOL
GRAYWATER SYSTEM
REPORT ID: DPR266 ROUTE TO BS0508