HomeMy Public PortalAbout4843 KAUFFMAN AVE_Sewer__ 76A 64,2D--CE808-10-71 APPLICATION
FOR PERMITCOUNTY OF LOS ANGELES SEWER-SEWAGE � -
DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS Yl
LOCALITY '�L4,4 ILI'
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER ��C�� Ue0,
/� MAIL / /f
BLOCK TRACT ' l ADDRESS — Z(p ' �/jl ,r-
NO. OF BLDGS. / &% �j!/�
SIZE OF LOT NOW ON LOT CITY TEL. NO. �LF
USE OF DISTRICT NO. GROUP MAP PRO SED BY
BUILDINGS '? mac_ /' (� B KK PS
CONTRACTOR .>� �� v- (/U -T-7 �[/ / 3
ADDRESS J pz t- —1770--V,p t /3 CONNECTION DATA
CITY ' I TEL. NO.2� 2— FL g STATION DEPTH
�
STATE a LIC MANHOLE REFERENCE UPPER
LICENSE NO.. ( '� Z CLASS LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER ONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $7.00
P.C.NO.
SEPT IC'TANK.SEEPAGE PIT OR
PITS AND/OR DRAIN LD @ 510.00 CO.IMP. NO. -108 NO.
HOUSE SEWER CONNEC ING TO TRUNK PERMIT NO. ROAD PERMIT NO. n.
PRIVATE DISPOSAL SYST @ S3.00 O
CONNECT ADDITIONAL BLD .OR AFFIDAVIT I WAIVER I-EASEMENT RECORD.INSTR.NO. DATE U
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAT FIELD ad'
EXT N..CESSPOOL.DRY W ELL. @ $5.00 HWY.OR STWIDENING O
ALTER,REPAIR OR ABANDON HOU . . F-
__SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT W
$
MANHOLE 7.00 PERMIT NO. a
N
INDUSTRIAL y
WASTE APPROVAL b
OWNERS PERMIT \$I s 00. CHARGEES
CONNECTION CHARGE FEE �/�,
AUTHORIZATION I TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SE �� APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF tL le- 19��jj�' 47
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS• --� �� BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
I HEREBY ACKNOWLEDGE THAT 4 HAVE READ fHIS 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 ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSEDAS REQUIRED BY LOS ANGLES COUNTY ND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNEjo OF AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE SC RE E IfIAL ROPE RTY. ABANDON HOUSE SEWER
SIGNATURE '
OF PERMITTEE BACKFILL SEPTIC TANKS ❑
SEEP.PIS) El CESSPOOLS ❑
_.....- T
VALIDATION CK M.O. CASH
4 3 65.0:0 a9