HomeMy Public PortalAbout5822 KAUFFMAN AVE_Sewer__ I
CE0011 ,
76A6420 0_63 - APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FADORESS
JOHN A. LAMBIE. County Engineer WILLIAM A. JENSEN, Supt of Building
FOR APPLICANT TO FILL IN 7
LEGAL
DESCRIPTION LOT NO OWNER
MAIL
BLOCK TRACT _ ADDRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
:I
BUILDINGS DISTRICT NO, GROUP MAP PROCESSED BY
)BK PG
C NTRACTOR
ADDRESS . CONNECTION DATA
STATION DEPTH
CITY TEL NO
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. � / /GO ❑ COUNTY LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION L TH FROM
HOUSE SEWER CONNECTING TO Y CURB P L M L T a
PUBLIC SEWER @ $S 00
SEPTIC TANK,SEEPAGE PIT OR PC.NO O
PITS AND/OR DRAINFIELD @ $1000 CO.IMP. NO. JOB NO V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG OR AFFIDAVIT W ER EASEMENT RECORD INSTR NODATE
WORK TO HOUSE SEWER @ $3.00 V
OVERFLOW SEEPAGE PIT,DRAINFIELD LU
EXTN,CESSPOOL,DRYWELL.MANHOLE @ $5,00 A r
ALTER, HOUSE __ HWY 5 1 NI Z
SEWER O M @ $300 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
RGES
OWNERS PERMIT s 2 Oo
AUTHORIZATION TOTAL FEE p CONNECTION C_ 'FE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON•/- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF _19—
OWNER
9_OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(5)
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ t
IHEREBY 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 HE LEGAL OWNER O AND INTEND TO DISCONNECT PLUG AND IV I
RESIDE IN, THE ABOVE CRIB SIDENTI P PE TY. - ABANDON HOUSE SEWER
SIGNATURE BACKFILLSEPTIC TANKS [_1OF,PERMITTEE SEEP,PIT IS) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
CK M O, CASH SUPERVISING MECHANICAL ENGINEER
LACO2 Q'o 0L1.2 JUN 21 1 O D 5.0 OM
• r
I
DEPARTNEFINT OF COUNTY ENGEN= 1 SEWER-SEWAGE DISPOSAL
OF BUILDING AND SAFETY i PERMIT APPLICATION
COUNTY OF LOS ANGE M
WILLIAM J. FOX, COUNTY ENOIN[[R II BUILDING 2� U 7n 2-h
ADDRE8S '\
"'- FOR AP LI ANT TQ/RLL-IN/",0 }
LOCALITY_'
OCALITY`
BUILDING ' NEAREST
ADDRESS VVV L'�'iD�"r� CROSS ST.
j
LOCALITYDISTRI TiNO. -Ready-for Inspection ppMRMIT NO.
{• I c
NEAREST /' J
CROSS ST. -
�RE�IVEBTf ` DATE• ISSUED BY DATE-
OWNER J��—/ ► 1
MAIL f�
ADDRESS USE ZONE OGl UPANCY BK MAP PG
R I�t•sti-f�NO. t
CITY '5- /zr
�E�...
CONTRACTOR J V v"
1
CO.IMP.N0.
ADDRESS 0 -�
10 B NO.
r
CITY TEL.NO. 1-'
TRUNK PERMIT NO.STATE ,
1
REGISTRATION NO. B COUNTY,
ROAD PERMIT N0.
LEGAL �j-
DESCRIPTION LOT N0. T- STATE ENCROACHMENT -
/ + PERMIT N0.
BLOCK TRACT .t INDUSTRIAL
® 0 WASTE APPROVAL
SIZE OF LOT NOW ON LOT NO.OF BLDG ^�-�+ CHARGES
USE OFco
I
BUILDINGS ` CONNECTION CHAJRGE FEE
NO. DESCRIPTION OF WORK FEE v ,y �-
HOUSE SEWER CONNECTING TOL ��7 REIMBURSEMENT FEE
PUBLIC SEWER f 3.50 v RECEIPT NO. ATEBY
HOUSE SEWER CONNECTING TO /
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_-WORK TO HOUSE•SEWER-- - -- 1.00 d `
ALTER OR REPAIR EXISTING }I.00 NO. I DATE I BY.
SEWER OR DISPOSAL SYSTEM
DISCONNECT AND ABANDON SEWER }
NO/OR-DISPOSALSYST EM- 1.00-... -CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR Q
PITS AND/OR GRAINFIELD 2.00
STATION -�A O / DEPTH
CESSPOOL—DRYWELL t
SPECIAL CONDITIONS ONLY 2.00- NHOLE REFERENCE
• - twleri-!e LOWER
TYPE OF CONNECTION , _,,-ffNGTH FROM /
OWNERS PERMIT s I 00,. Y. - CURB P.L. r M.L.TO P.L.
AUTHORIZATION - TOTAL FEE (j
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE-
DWELLING TO THE PUBLIC SEWER
SIGNED THIS__2_—___DAY OF__ --� - 19_``e NEW HOUSE SEWER I1•C ii �� \��Za
OWNER 0 �� �r CONNECT ADDITIONAL
OWNERS AGENT._'c 4� ___ '' BUILDING OR WORK
ADDRESS................_. �. I SEPTIC TANK,BEEP.PIT(S). -
- -- -- - --- - --- - - AND/OR GRAINFIELD
I 'HEREBY'ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL[]-DRYWELL -
CATION 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. I� SEWAGE DISPOSAL SYSTEM
I 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 1 AM THE LEGAL OWN ABANDON
THE ABOVE DESCRIBED R_ES1D NTIAL PROPERTY. f BACKFILL SEPTIC TANKS I]
SIGNATURE � + SEEP.PIT(S) CESSPOOLS
OF PERMITTEE/cv --�=f-
76A642D S&E 663 4/54
COUNTY OF LOS ANGELES # TEMPLE CITY # 0508 SEWER PERMIT
: DEPARTMENT OF PUBLIC WORKS 9071 LAS TUNAS SE 0508 9706240003
BUILDING—AND—SAFETY./ LAND-DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
SEWERLEGAL ID: P . S D
_ TR: 6561 LT: 495 EXIST OCC GRP: 5822 KAUFFMAN AV'
BLDGS. NOW ON LOT: TEMP'CA 917802205
Tgn,996IFTN FORMAT ION NUMB ER: CONNECTION TYPE: NEAREST-CROSS STREET: LAS TUNAS
8587-024-024 ORIGINATION: THOMAS PAGE: 597 GRID: A3 LOCALITY: TEMPLE CITY
LENGTH ML TO PL: STATION: DEPTH: ,
MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED B .
06/24%97 TC 06/24/98
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: - FINAL DATE FINA BY ODE:-
LONGOBARDI JOSEPH L;FRANCES H (818) 287-1836- JOB NUMBER:
5822 KAUFFMAN AV - TRUNK PERMIT NUMBER: !
TEMP 917802205 ROAD PERMIT NUMBER: DESCRIPTION
'AFFADAVIT: NO REPLACE SEWER LINE FROM HOUSE 0 APPROX. 901 OUT
WAIVER: . NO
0: EASEMENT: NO
RESCUE ROOTER (800) 269-6942-
RECORD INSTRUMENT NBR: RECORD DATE: " S ECIAL
HIGHWAY/STREET WIDENING: (N _
ESTATE ENCROACHMENT`-PERMIT-NUMBER:
CONTRACTOR: TEL. NO: 4 ��� �FEESiPAID A OV DATE INSPECTOR SIGNATURE-
RESCUE ROOTER - COVINA (800) 869-6942-
681 SAN BERNARDINO- LIC. NO FEE DESCRIPTION QUANTITY,: UOM: -HOUSE SEWER
'AMOUNT:
COVINA, CA 91724 C42 B * 05)
� 01%PERMI�T/ISSUANCE FEE ;A- 27.75 CONNECT ADDITIONAL
15,AbT/REP HOUSE SEWER 1.00 EAC 30.30 BUILDING OR WORK
ARCHITECT OR ENGINEER: p TOTAL-FEES 58.05" SEPTIC TSEEPAGE,
LIC. N0: y \', / �JU`JUU , AND/OP. DRAIN FIELD -.
Q�� j� b�RYWE
LL
SEWER MAP BOOK: PAG UFo)' EWER OR
O U C WORKS .,�U U KS • SEWAGALTERE DISPOSALS SYSTEM
C G AWU
61
0 •ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS —
O SEEP. PIT CESSPOOL
C�
* ADDITIONAL DATA ON FILE
REPORT ID: DPR266 ROUTE TO BS0508