HomeMy Public PortalAbout5939 KAUFFMAN AVE_Sewer__ - 420
76A6APPLICATION FOR PERMI
76A64e1/// •
COUNTY OF LOS ANGELES
DEPARTMENT OF COUNTY ENGINEER SEWER- EWAGE DIS AL
BUILDING AND SAFETY DIVISION BUILDING ry 'n
JOHN A. LAMBIE, County Engineer ADDRESS 3
WILLIAM A. JENSEN, Supt of Building
LOCALITYNEAR
FOR APPLICANT TO FILL IN
CR.SSJST. jf V GSI Q S
LEGAL
DESCRIPTION LOT I ` OWNER I ro /`,z
/ ✓ MAIL
BLOCK TRACT ((" - ADDRESSs Lo
NO. OF BLD GS. P
SIZE OF LOT NOW ON LOT 4�C
Y SLY CY7 TEL. .NO.�•'D
USE OF TRICT NO. GROUP MAP PROCESSED BY
BUILDINGS
` j
SK PGCONTRACTOR A•��,i_ADDRESS 0 • CONNECTION DATA
CITY &&'j & TEL. NO. /1{• 6 / ATION Cl / DEPTH
rf REGISTRATION NO, / qZ0/ ` NHOLE REFERENCE LOWER
NO. DESCRIPTION OF WORK FEETYPE OF CONNECTION LEND H FROM
HOUSE SEWER CONNECTING TO Y. CURB P,L. M.L.TO P.L.
PUBLIC SEWER ® $5.00
SEPTIC TANK,SEEPAGE PIT OR l P.C.NO.
PITS AND/OR DRAINFIELD 610.00 CO.IMP.NO, , ,� JOB NO, O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVRR I RAR[MRNT RECORD.INSTR.NO. DATE O:
WORK TO HOUSE SEWER ® $3.00 C
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPO O L,DRYWELL,MANHOLE® $5.00 -
EPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING U
EWER OR DISPOSAL SYSTEM ® 63.0000 LL
STATE ENCROACHMENT �/.
PERMIT NO. 7
INDUSTRIAL '
WASTE APPROVAL
OWNER'S PERMIT $
z Oo CHARGES
AUTHORIZATION TOTAL FEE G CONNECTION CHARGE FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED €XISTING DWELLING
TO THE PUBLIC SEW /� APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS,_DAY OF_A10 C_ ) 0
OWNER OR � NEW HOUSE SEWER
OW NERS,AGE NT 1 j CONNECT ADDITIONAL
ADDRESS
BUILDING OR WORK
'
I HEREBY-ACKNOWLEDGE*THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK,SEEP.PIT(S),
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 1 AM PROPERLY REGISTERED AND/OR ALTER.F% . R,SEWER OR
LICENSED AS RF6uIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
"CALIFORNIA OR THAT M THE LEGAL WNER AN IN NO TO DISCONNECT PLUG AND
RESIDE-IN, THE AB VE ESCRIB D fR ABANDON CT PL SEWER
SIGNATURE
BACKILL SEPTIC
OF PERMITTEE SEEP.PIT(S) T CETANKS
❑
VALIDATIOP-) ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
L: AL"'o 2 U 0'3DEC 4 1 0 D . ? S.Q 0~ _v
t r ..
i
COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT
DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0602070009
BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780
PHONE: (626) 285-0488 EXT:
LEGAL ID: SEWER / SEPTIC: SEWER BUILDING ADDRESS:
TR: 6561 LT: 120 BL: .001 EXIST OCC GRP: 5939 KAUFFMAN AV
BLDGS. NOW ON LOT: TEMP CA 917802235
ASSESSOR INFORMATION NUMBER: CONNECTION TYPE: NEAREST CROSS STREET: LAS TUNAS
8587-020-004 ORIGINATION: THOMAS PAGE: 597 GRID: A2 LOCALITY: TEMPLE CITY, C
LENGTH ML TO PL: STATION: DEPTH:
TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXPIRES ON:
5939-5941 KAUFFMAN 02/0'7/06 JK 08/06/06
COUNTY IMPROVEMENT NUMBER:
OWNER: TEL. NO: PLAN CHECK NUMBER: BI,*AL DATE FINAL BY: CODE:
JENSON, ROBERT (949) 493-6414- JOB NUMBER:
27061 CAMINO DE ESTR TRUNK PERMIT NUMBER:
CAPOSTRANO BEACH ROAD PERMIT NUMBER: DESCRIPTION OF WORK
AFFADAVIT: NO INSTALL CLEAN OUT FITTINGS TO GROUND LEVEL ON SINGLE LINE
WAIVER: NO DUPLEX
APPLICANT: TEL. NO: EASEMENT: NO
GOOD DAY PLUMBING INC. (626) 285-8080-
9729 E. LIVE OAK AVE RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS:
TEMPLE CITY CA 91780 HIGHWAY/STREET WIDENING:
STATE ENCROACHMENT PERMIT NUMBER:
CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPECTOR SIGNATURE
GOOD DAY PLUMBING INC. (626) 285-8080-
9729 E. LIVE OAK AVENUE LIC. NO FEE DESCRIPTION: QUANTITY: UOM: AMOUNT: NEW HOUSE SEWER
TEMPLE CITY, CA 91780 56548SBC36 '
I01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL
115 ALT/REP HOUSE SEWER 1.00 EAC 30.45 BUILDING OR WORK
ARCHITECT OR ENGINEER: TEL. N0: TOTAL FEES 58.20
- SEPTIC TANK, SEEPAGE PIT
LIC. NO: I AND/OR DRAIN FIELD
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 BS0506 -