HomeMy Public PortalAbout5807 KAUFFMAN AVE_Sewer__ DEPARTMENT OF COUNTY ENGEVEER SEWER-SEWAGE DISPOSAL
t DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEERI ADDREBUILDING �67
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REGISTRATION O. ,� y(1 g COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT.__�
p PERMIT NO.
BLOCK TRACT �p Y INDUSTRIAL
_ WASTE APPROVAL
SIZE OF LOT Q p 7� NO.OF HOW ON LOTS CHARGES
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USE OF 1 i®
BUILDINGS CONN ECT!ONICITAAE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ��^^
REIMBURSEMENT FEE
1 PUBLIC SEWER @ $ 3.50 > w RECEIPT NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM_ 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE 1BY
SEWER OR DISPOSALSYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 -CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
__P ITS
PITS AND/OR DRAINFIELD 2.00 STATION 1713,(:� DEPTH �Q
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFER NCQ•
UPPER !/ , / /,/ LOWER
TYPE OF CONNECTION LENGTH FROM /
OWNERS PERMIT S ( L' I 00 Y m CURB P.L. M.L.TO P.L.
AUTHORIZATION ( TOTAL FEE I 7 // �" —
1
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVDESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE USLIC SEWER _ -
���". 9d-_ NEW HOUSE SEWER (� GSs.
SIGNED THIS - F _ �' '�
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OWNER OR ` ( CONNECT ADDITIONALI y � L------ BUILDING OR WORK
OWNERS AGENT--------•-------------Yy-------- ------� ----•-------•.............
�^�jq �V �+ r �''��`� SEPTIC TANK,SEEP.PITS)
ADDRESS...._.?..b51._. .SY. �li _L F 'A _�..1..+4 x�....___...
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL
CATICN AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
V HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS.ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN
ER OF THE.ABOVE D IBED R IDE 0PERT BACKFILL SEPTIC TANKS
SIGNATURE SEEP_PIT(S) CESSPOOLS jCJ t w -
OF PERMITTEE.-_ _
7GA642D 663 1/53
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0803120001
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
ILEGAL ID: ISEWER / SEPTIC: SEWER BUILDING ADDRESS:
ITR: 6561 LT: 513 IEXIST OCC GRP: I 5807 KAUFFMAN AV
I IBLDGS. NOW ON LOT: TEMP CA 917802206
IASSESSOR INFORMATION NUMBER: (CONNECTION TYPE: I NEAREST CROSS STREET: 1
18587-021-003 (ORIGINATION: I THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY, Cl
I ILENGTH ML TO PL: STATION: DEPTH: I I
(TENANT: IMANHOLE REFERENCE: UPPER/LOWER: (ISSUED ON: PROCESSED BY: EXPIRES ON:
I I 103/12/08 SR 09/08/08 1
1 ICOUNTY IMPROVEMENT NUMBER: I
(OWNER: TEL. NO: IPLAN CHECK NUMBER: IFIUAI, DATE FIN BY: CODE:
ILAM, QUANG (626) 215-7412- IJOB NUMBER: I { f/(�
15807 KAUFFMAN AVENUE ITRUNK PERMIT NUMBER: 1
ITEMPLE CITY CA 91780 IROAD PERMIT NUMBER: 1lWS'fRIPTION OF WORK I
IAFFADAVIT: NO (CONNECT 2ND: UNIT TO PUBLIC SEWER
I (WAIVER: NO I 1
1APPLICANT: TEL. NO: (EASEMENT: NO I I
ILAI (626) 288-2651- 1 I 1
16748 VALLEY BLVD. #K (RECORD INSTRUMENT NBR: RECORD DATE: (SPECIAL CONDITIONS: I
IROSEMEAD, CA 91770 HIGHWAY/STREET WIDENING:
ISTATE ENCROACHMENT PERMIT NUMBER: 1
ICONTRACTOR: TEL. NO: I FEES PAID (APPROVALS DATE INSPECTOR SIGNATURE 1
1QUANG T LAM (626) 215-7412- I 1
IXIAO YING MAI LIC. NO 1FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: INEW HOUSE SEWER
19303 RALPH STREET NONE I I 1
IROSEMEAD, CA 91770 101 PERMIT ISSUANCE FEE 27.75 ICONNECT ADDITIONAL ✓'
1 103 CONN TO PUBLIC SEWER 1.00 CON 46.95 IBUILDING OR WORK
(ARCHITECT OR ENGINEER: TEL. NO: I TOTAL FEES 74.70 1 1 1 I
ILEE, PETER (626) 280-9000- 1 ISEPTIC TANK, SEEPAGE PITI
18748 VALLEY BLVD. #L LIC. NO: 1AND/OR DRAIN FIELD 1 I
IROSEMEAD CA 91770 NONE * I I I I
DRYWELL _
I SEWER MAP BOOK: PAGE: (ALTER, REPAIR, SEWER OR
SEWAGE DISPOSAL SYSTEM I 1
IDISCONNECT PLUG AND I I I
1ABANDON HOUSE SEWER I I I
I 1 IBACKFILL SEPTIC TANKS
SEEP. PIT _ CESSPOOL
IGRAYWATER SYSTEM 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
* ADDITIONAL DATA ON FILE 1 1 I I
IREPORT ID: DPR266 ROUTE TO BS0508 I
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