HomeMy Public PortalAbout4949 KAUFFMAN AVE_Sewer__ S. E-6D APPLICATION LI`�t/-o` ION Il O PERMIT
OS'.
S&E-683 3.88
DIVISION OF BUILDING AND SAFETY SEWER®SEWAGE-01SPOSAL
Deportment of County Engineer
County of Loa Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUwT OF.BUILDING LOCALITY ---...,T® le City
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
ADDRESS
(^ N0. OF BLDGS.
SIZE OF LOT aJ NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. - GROUP MAP
CONTRACTOR •. Potrero Plbaryy +/7 oo I • P
ADDRESS HaDarbington CONNECTION DATA
CITY so S.&n GabPiel TEL. NO. AT STATION DEPTH
n q�q�p A STATE MANHOLE REFERENCE UPPER
REGISTRATION N0. 1.0!$21 � COUNTY LOWER
No. DESCRIPTION OF WORK FEE — w -� o
HOUSE SEWER CONNECTING TO P O C C 0 . FROM
Y. - CURB P.L. td.L. TO P.L.
PUBLIC SEWER Q $ 3.50 -
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR - y P. C. N0.
WORK TO HOUSE SEWER 1.00 d CO. IMP. NO. JOB NO_.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. 4,IT
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK„ SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD .00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g .00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVE CON-
TRACTORTTOS DATE CONNECT THECTED ABOVEWITH THE DESCR BED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS —DAY OF 19— _._ 4
CONNECT ADDITIONAL
OWNER OR
OWNERS AGENT BUILDING OR WORK D
-
SEPTIC TANK, SEEP, PIT(S) I ��
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1'HAVE READ THIS APPLICATION CESSPOOL E3DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTEREDJAND/ORLICENSED AS REQUIRED BY LOS ANGELES COUNTY AND SDISCONNECT PLUG ANDCALIFORNIA OR THAT I AM THE LEGAL OWNER OF THABANDON HOUSE SEWER
DESCRIBED RESID TML PROPERTY, BACKFILL SEPTIC TANKS
T [I ❑
SEEP. PIT(S) CESSPOOLS❑
SIGNATURE
OF PERM[TTE - -
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION A•WOOD, CHIEF PLEIG. INSPECTOR
S&E•6E-683 11.55'D.
S . All P U C A T M N. FOR .PERMIT '
&
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL'
Department of County Engineer . m
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
Q CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY "
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL / OWNER -
DESCRIPTION LOT NO.
MAIL
BLOCK _ TRACT �i .� - ADDRESS
., . (�PI'��.�VO. OF(B7LDG5.
XCITY TEL. N0.
SIZE OF LOT (j! OW ON LOT
a
USE OF
BUILDINGS DISTRICT NO. GROUP' MAP
_
pn„a Y Ya
� - � BK PG
Imo/ Ail
CONTRACTOR 7
aCONNECTION DATA
ADDRESS r, .$ -
Pq j STATION 'DEPTH -
CITY � TEL. NO. ..� �r
N MANHOLE REFERENCE UPPER
ATE 6 0. LOWER
REGISTRATION-NO. I7 IJ3 ❑ COUNTY �L� /
.No. DESCRIPTION OF WORK FEE' �lj T-. s L/� ..
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM --
c Y_ CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00- -
OVERFLOW SEEPAGE PIT,DRAINFIELD ^P. C. N0. _ -
EXTN.',CESSPOOL,DRYWELL,MAN HOLE @ $ 2.00 CO. IMP.-NO JOB NO. -"
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM .- @ $1.00 TRUNK PERMIT NO. AD PERMIT
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT -
WORK TO HOUSE SEWER @ $1.00 C 'PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
g SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPRO
a
►✓""
- CHARGES
'CONNECTION CHARGE FEE - -
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE a 0-0 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -
TO.,THE PUBLIC SEWER. - NEW HOUSE SEWER 1 7>
SIGNED THIS DAY OF 19 rC
CONNECT ADDITIONAL �
OWNER OR BUILDING OR WORK'
OWNERS AGENT
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD 1 -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYW ELL❑ -
AND STATE THAT THE ABOVE 1S CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELE COU DISCONNECT PLUG AND
AND STATE OF ABANDON HO PLUGUSE D
CALIFORNIA OR THAT I PPM THE LEGA- 0 R F THE ABOVE I ER
DESCRIBED RESIDENTIAL PROPERs Y. p, BACKFILL SEPTIC TANKS El
SIGNATURE SEEP, PIT(S) ElCESSPOOLS❑
OF PERMITTEE 1VaZ4 -
JOHN A. LAMBIE, COUNTY E.cl EER ALIDATION ROBERT.A. WOOD, CHIEF Pt_BG. INSPECTOR
CK.' M.0. CASH -
Io 2 2 4 4 �� -- 2;Q-0
L _ _