HomeMy Public PortalAbout5112 KAUFFMAN AVE_Sewer__ cesoa:a-as COUNTY OF LOS ANGELES
DEPARTMENT OF.COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING / f
JOHN A. LAMBIE, County Engineer ADDRESS � L
CASSATT D. GRIFFIN, Sup't of Building LOCALITY
_,-:. ..«r. - - .: - ,a;.; NEAREST 7 _ 1.
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL - OWNER
` DESCRIPTION LOT NO.
MAIL
BLOCK TRACT / - ADDRESS Q.•.�•--t-_,.,.t°
1 NO.OF BLDGS. - i• - -
SIZE OF LOT NOW ON LOT CITY _./ Lam.-<t->Z• TEL.NO.
USE OF -
BUILDINGS %[ a DISTRICT N0.'. GROUP MAP P C Eq B
P
CONTRACTOR � �- ter; i/•` ,f
ADDRESS �'�' �/ , — CONNECTION DATA
p CITY r TEL. N0, TZ 'r S ON - DEPTH
/� �'] STATE IM
REGISTRATION NO. �� p�/ COUNTY A 0 R NCE'
NO. DESCRIPTION OF WORK. FEE �® LOwER-
HOUSE SEWER CONNECTING TO /
PUBLIC SEWER @. $3.00
SEPTIC TANK, SEEPAGE PIT OR - - 'TY .OF CONNE ION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 CURB P.L. M.L.TO P.)_.
OVERFLOW SEEPAGE PIT, DRAINFIELD.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM - @ $1.00, ^" "P.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0: - ROAD PERM NO.
Aej�VHOUSE SEWER @ '$1.00
3 A�WER; _ . 0 STATE ENCROACHMENT
_ @' $1.00 V MIT NO.
INDUSTRIAL -
?` WASTE APPROVAL
• CHARGES
OWNER'S PERMIT $ 2 OO CONNECTIO ARGE FEE
AUTHORIZATION TOTAL.FBE 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.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR. CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK -
,SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS R LATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM r/
_ I HEREBY CERTIFY THAT_I AM PROPER Y GISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED Y"LOS ANGELES UNTYAND STATE OFABANDON HOUSE SEWER
CALIFORNIA OR THA j -AM THE(LEGA WNER OF THE ABO
DESCRIBED RESIDDEENT PROPERTY. BACKFILL SEPTIC TANKS❑ ,
SIGNATURES P. PIT(S) SSP00 ❑
OF PERM, ;7 �� ? o
®r �TrO ROBERT A.WOOD
C r,p. s cAs1{ SUPERVISING MECHANICAL ENGINEER
• - '��"rfi��-'YfLj
CE808.8.98
COUNTY OF LOS ANGELES �����—SEWA ���P®��L-
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
FBUILDINGDDRESS. G�'-1•��JOHN A. LAMBIE, County EngineerCASSATT D. GRIFFIN, Sup't of Building OCALITY, LlfEAREST: ' � ;.
FOR APPLICANT TO FILL IN CROSS ST.
Y ,
LEGAL OWNER f
DESCRIPTION LOT N0. �
MAIL
BLOCK TRACT ADDRESS
NO.OF BLDGS.' - ,•' -
SIZE OF LOT NOW ON LOT CITY G"-'t—'�^L...r�' _.TEL.NO. _
USE OF. - _
BUILDINGS iLf i_ Q. _ > f y DISTRICT GROUP MAP P CESSELj,
f --t
,SII BK PG 't
CONTRACTOR�,� y} y Cmc :�'�
ADDRESS0a 04h 4am/Z_ CONNECT- N DATA
CITY TEL.N0. ION DEPTH
// STATE . . E. /
REGISTRATION NO. / `J— r /� COUNTY MANHOLE REFEREN-
NO. DESCRIPTION OF WORM FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 '0
SEPTIC TANK, SEEPAGE PIT OR _ TYPE OF CONNECTION LENGTH FROM', ,
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO - ' P.C. NO.
PRIVATE DISPOSAL.SYSTEM @ $1.00 @. JOB NO. � '
CONNECT ADDITIONAL BLDG.Oft TRUNK,PERMIT NO., ROAD-PERMIT To.
O K TO HOUSE SEWER - @ $1.00
R OR ABANDON HOUSE STATE ENCROACHMENT
@ 1. PERMIT-419. -
.,INDUSTRIAL
WASTE APPROVAL
Z CHARGES
OWNER'S• PERMIT $ CONNE N CHARGE FEE
AUTHORIZATION TOTAL FEE ':° 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.
SIGNED-THIS-------DAY OF 19_ NEW HOUSE SEWER
OWNER OR _ CONNECT ADDITIONAL -
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD -
1HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY s CESSPOOL❑ DRYWELL❑WITH ALL COUNTY ORDINANCES AND STATE LAW ._REGULATING ALTER, REPAIR,SEWER OR - - -
PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY EGISTERED AND/OR
LICENSED AS REQUI 7BY !OS AN ELES OUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR T T�I AM THE GA OWNER OF THE ABOVE
ABANDON HOUSE SEWER
DESCRIBED'RESID y AL PROPERTY BACKFILL SEPTIC TANKS❑
P.P[T(S) ❑ SPOOLS
SIGNATURE
OF PERMITTE71
OF / LIDATIO -
ROBERT A.WOOD
M.0 SUPERVISING MECHANICAL ENGINEER
X�-�,