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HomeMy Public PortalAbout5024 KAUFFMAN AVE_Sewer__ 7GA64470 APPLICATION FOR PERMIT �5&E•R+�3 IV11-55 7 DISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL 1 Department of County Engineer County of LOS Angeles BUILDING S� �— I / JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ® CASSATT 0. GRIFFIN. SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS sr. LEGAL DESCRIPTION LOT NO. OWNER �� ��_, �-�` y.;,_>-,,�., -"'•'^ MAIL BLOCK TRACT ADDRESS •--', :^. '�,a. ..,. <:�_.�,,,,>,.�••�'., z:---,. •.,_,,d,.�✓, 1 NO. OF BLDGS. CITY TEL, NO. SIZE OF LOT NOW ON LOT USE OF - BUILDINGS DISTRICT NO. GROUP MAP BK PG CONTRACTOR CONNECTION DATA ADDRESS STATION DEPTH CITY TEL. N0. MANHOLE REFERENCE UPPER ❑ STATE LOWER REGISTRATION NO. ❑ COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. N0. EXTN.,CESSPOOL,DRYWELL,MAN HOLE t?n $2.00 CO. IMP. NO. JOB NO. I HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO, CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT t WORK TO HOUSE SEWER (2d $1.00 L (� PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM $1.00 a, WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNERS PERMIT $ 1 00 REIMBURSEMENT FEE 2 AUTHORIZATION TOTAL FEE U I HAVE AT THIS DATE A CONTRACT WITH 7HE HEREIN NAMED co N- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER 1, \ SIGNED THIS DAY OF 19 CONNECT ADDITIONAL OWNER OR BUILDING OR WORK ) !'•,_ .I ` •rte�c.„�.� OWNERS AGENT SEPTIC TANK,SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SIGNATURE T SEEP.PIS) ❑ CESSPOOLS[I OF PERMITTEE JOHN A. LAMBIE, COUNTY ENGINEER VALIDATIOD._, ROBERT A.WOOD,CHIEF PLBG. INSPECTOR CK. M.0. � 'C5059� APR1? 4 2.00 t Dh PAkCT1iEENT OF COUNTY ENG11NEER SEWER-SEWAGF., DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS,ANGELES WILLIAM J. FOX, ` COUNTY ENGINEER BUILDING�I ADDRESS "'' - P / LOCALITYe C FOR APPLICANT, TO FILL. IN r- , ABUILDING DDRESS NEAREST P" a CROSS ST. yj LOCALITY ortf DISTRICT NO. SERIAL N0. PERMIT N0. NEAREST s CROSS ST. I �D p+� ' ` RECEIVED BY Ready for Inspection DATE ISSUED OWNER ° /J� /"QI""4 ¢Ji ,/ "' 1` Z A �. c ADDRESS g� f� USE,ZO _1 OCCUPANCY MAP MAIL � J Gr �� �' if�� BK PG CITY TEL.NO. a A — ` t G, C)Q CONTRACTOR a �sg� .\ C• � ADDRESS JOB N0. CITY TEL.NO. I TRUNK PERMIT NO. ❑❑ STATE REGISTRATION NO. ❑ COUNTYi ROAD PERMIT NO.- LEGAL O.LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO. PERMIT NO. BLOCK TRACT OV&V,3 a INDUSTRIAL WASTE APPROVAL I3LDGSIZE OF LOT ✓ �{® LOTS p4 NOW„ON CHARGES . OF USOF 9 BUE DINGS .. f _4 R `% CONNEC N CHARGE FEE NO. DESCRIPTION Of WORK` FEE If HOUSE SEWER CONNECTING TO 11 REIMBURSEMENT PUBLIC SEWER @ $ 3.50 i RECEIPT NO. I D I BY HOUSE SEWERCONNECTING TO _ PRIVATE DISPOSAL SYSTEM , 1.00 4j CONNECT ADDITIONAL BLDG.OR i XCEPTION RECORD.€D WORK TO HOUSE SEWER 1.00 C4. NO. I DATE ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM - 1.00 DISCONNECT AND ABANDON'SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00LOWER HOLE REFERENCE - 0-1 UPPER I OF CONNECTION LENGTH FROM q OWNERS PERMIT 1 00 'j C ,RB P.L. M.L.TO P:L. AUTHORIZATION ( TOTAL FEE Z C)©{ 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED, t1 CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING1 APPROVALS INSPECTOR'S SIGNATURE (DyATE DWELLING TO THE PUBLIC SEWER SIGNED THIS....................DAY OF.---•------------•--------..............19-----�` NEW HOUSE SEWER A OWNER OR CONNECT ADDITIONAL ' i OWNERS AGENT------------------------------..-_--_--------------.----------_--•---- - BUILDING 0 R W O RK __.__._____ SEPTIC TANK,SEEP.PIT(S) If ADDRESS--_ )� ------------------------__------•-------------------------............. AND/OR DRAINFIELD F I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL I] DRYWELL r CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE; TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR 9 `� 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 1 AM THE LEGAL OWN- ER OF THE ABOVE.DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I] SEEP.PIT(S)C] CESSPOOLS[] SIGNATURE OF PERMITC�d�T ---`� -'i-% 76A642A 663 7/53