HomeMy Public PortalAbout4850 KAUFFMAN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER f SEWER®SEWAGE. DISPOSAL
DIVISION OF BUILDING AND SAFETY �'.: PERMIT APPLICATION
COUNTY OF UOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ) BUILDING �®
ADDRESS
FOR APPLICANT TO FILL
IN LGcaurY
r BUILDING NEAREST
ADDRESS "%.fej&Aw..�z&uZ CROSS ST.
LOCALITY }" DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST ,5, 49 A "3
CROSS ST.
RECEI ED BY Ready for Inspection DATE ISSUED
OWNER � a���� �
MAIL
ADDRESS Ujr ZONE OCCUPANCY MAP s
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CITY yL � TEL.NO
CONTRACTOR
CO.IMP.NO.
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ADDRESS
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CITY At 4hzd! TEL. 0. J /� TRUNK PERMIT N0.
❑ STATE
REGISTRATION NO �+� [ C!)4JidTM;y ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT,
DESCRIPTION T N0. (� PERMIT NO.
BLOCK TRACT L01A WASTE APPROVAL ^
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF ^- -
BUILDINGS GJ CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT`FEE` - --
HOUSE SEWER CONNECTING TO {
PUBLICSEWER ' @ $ 3.50 RECEIPT NO. DATE --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, DATE
_I-DATE BY
SEWER OWDISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.001 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION " � � _ DEPTH
CESSPOOL-DRYWELL'
SPECIAL CONDITIONS ONLY 2.00209 MANHOLE REFEgEJICE
+WJWZR es LOWER
TYPE OF CONNECTION LEN G-T.H.FROM'-
OWNERS PERMIT $ I 00 Y ` CuRg-� P..L P.L.
AUTHORIZATION I TOTAL FEE
I 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-----------•--------DAY OF........................................19---..... NEW HOUSE SEWER ��� �' a •�"
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT....
._------------------_. BUILDING OR WORK
_.
SEPTIC TANK,SEEP.PIT(S)
ADDRESS- - -- - ------------ AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL I] 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. 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 I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBMESF ,AL PROPERTY. BACKFILL SEPTIC TANKS
+
SIGNATURE SEEP.PIT(S)E] CESSPOOLS 13.OF PERMITTEE - -
76A642D 663 1/53