HomeMy Public PortalAbout4846 KAUFFMAN AVE_Sewer__ fi. DEPARTMENT OF COUNTY ENGYNEE'R . i SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY' ENGINEERBUILDEINSSG
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ALITY n DISTRICT N0, pSERIAL N0. PERMI/T7N�0. CAREST v / �I D aR ~ I g�pA�J — JSS ST./� y� RECEIVED BY Ready for Inspection 1 DtATE I1SSUEDNER (s .�� . dwi7� J i1G�eC^iQ1 I /1� I�3
MAIL ADDRESS 9. �a USE ZONEe OCCUPANCY BK MAP PG
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CITY TEL.NO' a 3 ✓ - ' M '� - 3
CONTRACTOR ���rl CO.IMP. NO.
ADDRESS ya $� (jf�y�,. LGI / JOB NO.
CITY TEL.N0 ,' 4 XA:W. TRUNK PERMIT NO.
_ e
, . m STATE
REGISTRATION N0. �Y
ROAD PERMIT NO.
LEGAL S
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO. '
BLOCK TRACT �� WA TEAPPROVAL
SIZE OF LOT,:;-oN0.OF BLDGS. CHARGES
}( /a! NOW ON LOT
USE OF
BUILDINGS / r.�x'1� CONNEC CHARGE FEE
NO. DESCRIPTION OF WORK . FEE
HOUSE SEWER CONNECTING TO ,�!'
REIMBURSEMENT FE
PUBLICSEWER @ $ 3.50 ,I O RECEIPT NO. I Af I BY
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 I BY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR I /
PITS AND/OR"DRAINFIELD 2.00 STATIOI*G.F- 1.� , '5- DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 34 SSI i1 Cq MANHHOLEEREFERENCEQEm LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 00 �Y_r , Com' M.L.TO P.L. /'-�.
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE.HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGN,ATURE DATE
DWELLING TO THE.PUBLIC SEWER
SIGNED THIS....................DAY OF---------------------------------------19----- NEW HOUSE SEWER .P Iry 2 i1j
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT------------------------------------------------------.---------•- - BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS-------------•----------------------------------------------------------------------------- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I.HAVE READ THIS APPLI- v CESSPOOL.O DRYWELL E]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. SEWAGE DISPOSAL SYSTEM
1 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 DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
a SIGNATURE �^ SEEP.PIT(S)o CESSPOOLS
OF PERMITTEE..._...:...- - -._......_......_... ...-
76A642A 663 7/53 �y �i �