HomeMy Public PortalAbout5121 KAUFFMAN AVE_Sewer__ N•76A842D A P tl �a�C A 9 �7 O ®R PERMIT- 1
l E R tl C'S Fi I T
CE808 II-87 COUNTYOF LOS ANGELES
_ _ - SEWER-SEAGE ,'®5SP®SA'L
DEPARTMENT OF'COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING.
JOIN A. LAMBIE, County EngineerADDRESS: / r2fs� L of
CASSATT D. GRIFFIN, Sup! of Building LOCALITY -54 ��.a._ A^ -
ERE
OR APPLICANT TO FILL IN ceoss sr:
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TION LOT N0. 'OWNERMAILL, / �q TRACT - ADDRESS w-J`•� ••Q/-NO.OF BLDGS.OT NOW ON LOT CITY�o - L.N0mw
GS - DISTRICT NO. GROUP MAP
rBTOR J CONNECTION DATA
r - TEL.N � 'r g - STATION - DEPTH
EMANHOLE REFS C UPPER
REGISTRATIO N0: ❑ COUNTY .,. - LOWER
NO. j D Ca]PTION OF WORK FEE
HOUSE SEWER CONNECTING TO
- PUBLIC SEWER @ $3[* ��
` -SEPTIC TANK,SEEPAGE,PIT OR • TYPE OF CONNE TI NGTH FROM
:a PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P M.L.TO P.L.
OVERFLOW SEEPAGE PIT',DRAINFIELD 0
ER TN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING T0. _ P.C..
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. - .JOB N0.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER . @ $1.00 (E/ L,/ TRUNK PERMIT NO'. - ROAD PERMIT -
ALTER,REPAIR OR ABANDON HOUSE - '-
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT .
PERMIT NO.
INDUSTRIAL
:. .;: - WASTE APPROVAL.. _
CHARGES
OWNERS PERMIT' $ 00, CONNECTION CHARGE FEE - -
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I.HAVE AT THIS DATE•A-CONTRACT WITH THE HEREIN NAMED CON,
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19 NEW HOUSE SEWER'
__ _ _ . ..__ CONNECT ADDITIONAL ....
OWNER-OR-= -- -� {{qg. ,,�•-
OWNERS AGENT _ ' BUILDING OR WORK = aa1-�f�v -
SEPT] -TANK;-SEEP,-PIT(S) - -• ------•-- ^•-- _
ADDRESS . :_.__--.-...___.._..__ ... _. .. _.__ ,.,_ ..._ __ ---'^--
_..._ _.. --'""_. _.• AND/OR`DRAINFIELD",
I HEREBY ACKNOWLEDGE THAT 1, HAVE READ THIS APPLICATION .'-•••�`d="•i "+ -
AND-STATE, THAT,_THE,._ABQVE. IS_CORRECT.AND_AGREE•.T.O_COMPLY.,., CESSPOOL-^E]--DRYWELL--0 :t ^"•"`•-'`•_..-__.
WITH ALL COUNTYORDINANCESAND STATE LAWS REGULATING -�
PLUMBING AND SEWERS. ALTER,REPAIR, SEWER OR'.
"' ,
1-"HEREBY' CERTIFY THAT 'I"AM `PROPERLY "REGISTERED-AND/OR -SEWAGE-DISPOSAL-SYSTEM --,-- •- •--•- V.-• _ - _,._,,...„..
LICENSED AS REQUIRED BY' LOS, ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND -
CALIFORNIA OR THAT I A THE.,,L'EGAL .OWNER OF. THE. ABOVE .ABANDON.HOUSE SEWER__._-
DESCRIBED RIP ENTIAL PERTY. BACKFILL SEPTIC TANKS E:1 -
SIGNATURE •_�: SEEP. PIT(S) El CESSPOOLS El - y
OF PERMIT TFF,
- _
.._.:. VALIDATION. .. - ROBERT A.WOOD
CK. _ M.0. cAsx. SUPERVISING MECHANICAL ENGINEER
- y 8.1.3 4 1.7-I- A `3: ry:'
s ..
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 1105030002
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE. CITY CA 91780
PHONE: (626) 285-0488 EXT:
{LEGAL ID: ISEWER / SEPTIC: SEWER { - BUILDING ADDRESS: {
{TR: 15683 LT: 39 IEXIST OCC GRP: { 5121 KAUFFMAN AV {
{ {BLDGS. NOW ON LOT: { TEMP CA 917803946
{ASSESSOR INFORMATION NUMBER: ICONNECTION TYPE: NEAREST CROSS STREET: LA ROSA
18589-011-011 {ORIGINATION: THOMAS PAGE: 597 GRID: A4 LOCALITY: TEMPLE CITY, Cl
{ _{LENGTH ML TO PL: STATION: DEPTH:
{TENANT: IMANHOLE REFERENCE: UPPER/LOWER: (ISSUED ON: PROCESSED BY: "�`
{ - 1 105/03/11 SR {
{ ICOUNTY IMPROVEMENT NUMBER: I .
{OWNER: TEL. NO: IPLAN CHECK NUMBER: F NAL DATE FIN ,$yY: CODE:
ITAKEDA NORMAN L;SUZANNE (626) 287-8771- IJOB NUMBER: I /' I � ��/ I
15121 KAUFFMAN AV (TRUNK PERMIT NUMBER: {J if
ITEMP 917803946 IROAD PERMIT NUMBER: {DESCRIPTIONOF WORK
IAFFADAVIT: NO {INSTALL A 2 WAY CLEAN OUT ON SEWER
(WAIVER: NO
(APPLICANT: TEL. NO: (EASEMENT: NO {
IBRUCE SMYTHE (310) 838-0408- 1
13801 LENAWEE AVE IRECORD INSTRUMENT NBR: RECORD DATE: ISPECIAL CONDITIONS: {
ICULVER CITY CA 90232 (HIGHWAY/STREET WIDENING: {
{ (STATE ENCROACHMENT PERMIT NUMBER:
{CONTRACTOR: TEL. NO: { FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE
{MIKE DIAMOND PLUMBING (310) 253-5229- 1 1
13801 LENAWEE AVE LIC. NO IFEE DESCRIPTION: QUANTITY: UOM: AMOUNT: INEW HOUSE SEWER
{CULVER CITY CA 90232 399170/C36 I I 11
{ 101 PERMIT ISSUANCE FEE 27.80 {CONNECT ADDITIONAL I I 1
{ 115 ALT/REP HOUSE SEWER 1..00 EAC 30.40 (BUILDING OR WORK 1
{ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 58.20 I
{ - I . ISEPTIC TANK, SEEPAGE PIT{ I I - -
{ LIC. NO: I (,AND/OR DRAIN FIELD {
{ IDRYWELL _ { {
{ I {
{. SEWER MAP BOOK: PAGE: { {ALTER, REPAIR, SEWER OR {
{ ( {SEWAGE DISPOSAL SYSTEM - I
{ I { I I {
{ {DISCONNECT PLUG AND { {
{. ; (ABANDON HOUSE SEWER
{ I I { { I
1 1 IBACKFILL SEPTIC TANKS
I. {SEEP. PIT _ CESSPOOL _ {
. IGRAYWATER SYSTEM I I- I.
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I IREPORT ID: DPR266 ROUTE TO ES0508 { 1"