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Home My Public Portal About6237 KAUFFMAN AVE_Sewer__ ' TEMPLE CITY CEBU_ I2-aB=••- 76A 6420 APPLICATION FOR PERMIT - COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN'A. LAMBIE, COUNTY ENGINEER ADDRESS 6237 N COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY Temple City FOR APPLICANT TO FII.L IN CROBSSST. Longderl LEGAL T DESCRIPTION LOT NO. OWNER tJ • L• Brainard MAIL BLOCK TRACTmay^''/,`" RIVI412 ADDRESS 6237 ffman Ave, NO. OF BLDGB. /'� SIZE OF LOT NOW ON LOT CITY T s C a TEL. NO. USE OF D DISTRICT NO. GROUP MAP CESSED BYE BUILDINGS Res. BK PG CONTRACTOR i�I SG �j 6 ADDRESS Rd. VV U CONNECTION DATA CITY EI l me TEL. NO 1,�./.�4-2 2 STATION /� .,/Z 7 DEPTH 4 . LICENSE NO 1.288 0 CLASTATE LIC SS C... 2 MANHOLE REFERENCE {.� • O �G�J LOWER No. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM&r ` HOUSE SEWER CONNECTING TO Y P L. M L.TO P.L. J I PUBLIC SEWER $5 00 SEPTIC TANK.SEEPAGE PIT OR 2 /j P.G.NO. PITS AND/ OR DRAINFIELD ® SIO 00 CO IMP NO. /�J G� JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.93/= CL PRIVATE DISPOSAL SYSTEM @ $300 Y� CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER E15E11MT RECORD INSTR NO. DATE U WORK TO HOUSE SEWER Q $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD D= EXTN CESSPOOL DRYWELL.MANHOLE 0 $5.00 CD ALTER.REPAIR OR ABANDON HOUSE HWY OR ST WIDENING V SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT � PERMIT NO (n 4= INDUSTRIAL Z WASTE APPROVAL OWNERS PERMIT z 00 CHARGES AUTHORIZATION TOTAL FEE6 6 CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR T0.CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS D E INSPECTOR'S SIGNATURE SIGNED THIS DAY OF -19- OWNER g_OWNER OR NEW HOUSE SEWER Z OWNERS AGENT_ CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL IHEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUN Y AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER F. AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE ABOVE DESCRIBED RESIDENT L PROPERTY. ABANDON HOUSE SEWER 1 SIGNATURE BACKFILLSEPTIC TANKS T [:1 ❑ ,�1❑ � OF PERMffTEE SEEP.PIS) CESSPOOLS - �',,,rc i.r VALIDATION JACK-R. ALLEN M 0 CASH SUPERVISING MECHANICAL ENGINEER Sk �. 9787,v- APR 1910 0 7.00 4 76A 642D - CE808 - 9/73 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING y ADDRESS LOCALITY MI NEAREST FOR APPLICANT TO FILL IN CRosS ST. j LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP BK MAP PROCESSED BY P5 F CONTRACTOR , (4, '� e /_ GGGJJJ 1 ADDRESS `�, CONNECTION DATA CITY TEL. NO. STATION i2 DEPTH STATE LIC G L�Z P ER LICENSE NO:, CLASS 1� i MANHOLE REFERENCE • P p NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER Q $7.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR DRAINFIELD $10.00 CO.IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ 83.00 CONNECT ADDITIONAL BLDG.OR AFFIDAV7WAIVER [As[x[xr RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 d OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL.DRYWELL. $5.00 CJ " "�''� HWY.OR ST.WIDENING AOR ABANDON HOUSE _ � SEWER OR 'J 83.00 STATE ENCROACHMENT CD MANHOLEQ $7 00 PERMIT NO. W INDUSTRIAL 0- WASTE APPROVAL Z OWNERCHARGESS PERMIT s AUTHORIZATION I TOTAL FEE ACONNECTION CHARGE FEE � ITHAVE AT THIS DATE A CONTRACT WIH 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 ��'�C_° 19� OWNER OR NEW HOUSE SEWER OWNERS AGENT_ C-...�+<�"'t/ IF/ CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) 1 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 Cl 1HEREBY 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 CCALIFCIR NIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND 6� RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. 'z A ABANDON HOUSE SEWER an SIGNATURE OF PEQ MTTTEE BACKFILL SEPTIC TANKS ❑ -s SEEP.PIT(S) Cl CESSPOOLS ❑ VALIDATION CK, M.0. ASN .lJ 0