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HomeMy Public PortalAbout4910 KAUFFMAN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX. COUNTY ENGINEER BUILDING CABSATT D. GRIFFIN,*SUPT OF BUILDING I ADDRESS �v,q LlG FOR APPLICANT.TO FILL IN LOCALITY � 1� BUILDING �✓ NEAREST ADDRESS CROSS ST. SO u { p 2p•(y LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. � `A� 5 A NEAREST /!/spp01 CROSS ST. w ren 9i'rh{ {/ RECEIVED BY Ready for Inspection DATE ISSUED OWNER �r i ej/D MAIL - a USE ZONE OCCUPANCY MAP ADDRESS !�Ih ,l � r Cr,ra;. �� BK PG CITY TEL.NO. � CONTRA TOR , CHARGES REIMBURSEMENT FEE +' REQUIRED ADDRESSie— NOT REQUIRED CITYTEL.NO. �9{ _ CONNECTION.CHARGE FEE JOB NO. ��Q�4 STATE CO. IMP.NO. REGISTRATION N0: �"' Cfl.U�N:T-Ys+ LEGAL ' RECEIPT NO_ DATE (BY 'DESCRIPTION LOT N0. 54 Q _ r BLOCK TRACT © WAIVER FOR RECORDING SIZE OF LOT NO.OF BLDGS. RECEIPT N0. I DATE I BY NCW ON LOT USE OF A BUILDINGS dS TRUNK PERMIT NO. NO. "=.DESCRI TION OF-WORK FEE HOUSE SEWER CONNECTING TO ROAD PERMIT NO. EZ f Aoo PUBLIC SEWER @ $ 3.50 I 5 HOUSE SEWER CONNECTING TO STATE ENCROACHMENT PRIVATE DISPOSAL SYSTEM 1.00 PERMIT NO. CONNECT ADDITIONAL BLDG.OR I I INDUSTRIAL WORK TO HOUSE SEWER 1.00 WASTE APPROVAL ALTER OR REPAIR EXISTING I SEWER OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 ( STATION4-/J C DEPTH SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 I MANHOLE REFERENCE S f L, f1-111 1-/ CESSPOOL—DRYWELL _ SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONNECTION LENGTH FROM O Sful2 CURB P.L. M.L.TO P.L. — OWNERS PERMIT $ 1 00 _ -S t✓ /r'l �a7��• _ AUTHORIZATION I TOTAL FEE 5-0 COAED NTRACTOR TO CONNECT THE ABOVE D SCRIBEDI EXIISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS... ... � 3a��",-- I NEW HOUSE SEWER ....DAY OF......-- - �I9- _:,3 — s CONNECT ADDITIONAL OWNER OR BUILDING OR WORK OWNERS AGENT-...------- �. .... .................. • pp.B� SEPTIC TANK,SEEP.PIT(S) ADDRESSAND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I'HAVE READ THIS APPLI. CESSPOOL(] DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER REGULATING PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND DISCONNECT ABANDON HOPLUG PLUG AND EWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN ER,OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ' SEEP.PIT(S)[:] CESSPOOLS SIGNATURE ' OF PERMITTEE--W-..!. -. !..- to—. 76A642D 663 12/52