HomeMy Public PortalAbout4900 KAUFFMAN AVE_Sewer__ IDEFARTA[ENT OF COUNTY ENGINES l SEWER-SEWAGE DISPOSAL .
DIVISION OF BUILDING AND SAFETY i PERMIT APPLICATION
COUNTY,OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING /►
! ADDRESS '�®(/
FO ---'APPLICANT TO F L IN LOCALITY
BUILDINGNEAREST
'ADDRESS- ..z/ ® 6, ''„V G�� CROSS ST. IA til a::t"-t-..S 0--
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A
CROSS ST.
414 RECE VED Y Ready for Inspection DATEISSUED
OWNER �
ADDMAIBt:ZONE OCCUPANCY MAP U
ADDRESS .I BK PG
CITY TEL.NO /.
CONTRACTOR � •J
CO.IMP.N0.
ADDRESS JOB.NO. /='
I
CITY TEL.NO s TRUNK PERMIT N0. / —
REGISTRATION NO. ����� �� � �psCQU"Y ROAD PERMIT NO.
LEGAL6' / STATE ENCROACHMENT
DESCRIPTION LOT N0. k� PERMIT NO.
BLOCK TRACT WASTE APPROVAL
USTRIAL
SIZE OF LOT N0.OF BLDG8.
NOW ON LOT CHARGES
USE OF
BUILDINGS /" .+� - CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER'CONNECTING TO REIMBURSEMEflT:FEE'
PUBLICSEWER @ $ 3.50 .J RECEIPT NO. DATE BY _
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR_ EXCEPTION RECORDED
WORK TOMOUSE SEWER 1.00 i
ALTER OR REPAIR,EXISTING N0. I DATE JB
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 _ CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR ?
_ PITS AMD/OR DRAlNFIELD 2.00 i .STATION. �J G DEPTH /
CESSPOOL—DRYWELL L
SPECIAL CONDITIONS ONLY 2.00L� 1� MANHOLE REFERENCE
UPPER hHY71?R
a TYPE OF CONNEC.T-ION LENGTH FROM•
OWNERS I PERMIT $ I 00 1 Y. ✓ rpu•RB— P:LA'- "-M.L:TO`P.L.
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED'
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING j APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF - - IQ CONNECT ADDITIONAL NEW HOUSE SEWER �C' �:5
OWNER OR '
OWNERS AGENT-----------------------------------------------------•----------------•---- BUILDING OR WORK
4
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..............---------------------------------------.................. AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-1 CESSPOOL I] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREEI
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL.SYSTEM
1 HEREBY CERTIFY THAT 1 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 R SIDENTIAL PROPERTY. ( BACKFILL SEPTIC TANKS I]
SIGNATURE
�Fj i - SEEP.PIT(S) CESSPOOLS
OF PERMITTE - -- --- •-• ----::--`•.- -- --------
E ----I
76A6 42D 663 1/53 I