Loading...
HomeMy Public PortalAbout5138 KAUFFMAN AVE_Sewer__ b 76A 6420 -CE808 -10-71 f fes rERA O4PPOCAF COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL. DEPARTMENT OF COUNTY ENGINEER — — BUILDING AND SAFETY DIVISION BUILDING j ADDRESS LOCALITY ( C, NEAREST / FOR APPLICANT TO FILL lid CROSS 5T. c-4 -l2 • �— LEGAL DESCRIPTION LOT NO. OWNER MAIL l / BLOCK TRACT / � Get*-_3 ADDRESS � � „3 �'�.' i ! � • NO. OF DS. BLG SIZE OF LOTl� NOW ON LOT CITY /�: ��K TEL. NO.USF �- - �/.J• /,a r _ DISTRICT NO. GROUP MAP OCESSED BY BUILDNGS �'`r j ,�/•<"_y BK p3 CONTRACTOR f i'I. iVi"7'i�7"i•�/ •/Y ,7 n�-' � �fi� � I � _ - ADDRESS � -.s `.t... ►,;,• _ ,•.�_ CONNECTION DATA y/�' 't STATION DEPTH CITY fly .�l C TEL. NO. � � STATE ��. LIC MANHOLE REFERENCE UPPER LICENSE NO.. - 6� k CLASS LOWER NO. .DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P:L. M.L.TO P.L. PUBLIC SEWER @ $7.00 P.C.NO. SEPTIC TANK,SEEPAGE PIT OR JOB NO. - PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. G. PRIVATE DISPOSAL SYSTE @ S3.00 O CONNECT ADDITIONAL B2. /'. AFFIDAVIT WAIVER '[n SEMS xi RECORD. INSTR.NO. DATE V WORK TO HOUSE SEWER @ $3.00 L./ OVERFLOW SEEPAGE PIT.DRAINFIELD CC EXTN..CESSPOOL.DRYWELL, @ $5.00 O ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT W MANHOLE @ $7.0 PERMIT NO. LL INDUSTRIAL N WASTE APPROVAL z OWNER'S PERMIT S s 00 CHARGES AUTHORIZATIONJ TOTAL FEE /i CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEW APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OFf"�e`"''•' 19 � OWNER ORNEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK /1'`� l AJrsOYN / SEPTIC TANK.SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _ WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL Cl I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR - ALTER,REPAIR,SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE �i BACKFILL SEPTIC TANKS ❑ OF PERMffTEE SEEP.PIT(S) ElCESSPOOLS ❑ VALIDATION CK. M.O. CASH 4 b y t► ii 1 y OU 76A642D rA P P L I C gAB"•0tl I O 1!� "FO PERMIT - 6&E.663 12-54 Y t1 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County Of LOS Ange10S BUILDINGRNO. WM.J:FOX, COUNTY ENGINEERADDRESSCASSATT D. GRIFFIN°Sup�•r of BUILDING LOCALITTc4 FOR APPLICANT TO FILL IN NEARESTCROSS ST. galLEGALDESCRIPTION LOT N0. OWNERBLOCK TRACT - AIL pDRESSNO. OF BLDGS.SIZE OF LOT NOW ON LOT CITY USE OF BUILDINGS DISTRICT NO. GROUP MAP PG BK CONTRACTOR ADDRESS /�' .y. ✓ CONNECTION DATA CITY A4Uw1_-1 vA4TEL. NO.69 S—I/12-1 STATION DEPTH U( STATE -MANHOLE REFERENCE REGISTRATION NO. . S3 ❑ COUNTY UPPER - 'LOWER- - TYPE OF CONNECTION LENGTH FROM NO. DESCRIPTION OF WORK FEE Y. 'CURB P.L. M.L.TO P.L. HOUSE SEWER CONNECTING TO PUBLIC SEWER Ccs -S 3.50 _ HOUSE SEWER CONNECTING TO - PRIVATE DISPOSAL SYSTEM 1.00_ CONNECT ADDITIONAL BLDG. OR. CO. IMP. N0. JOB. N0. ' WORK TO HOUSE SEINER 1.00 / ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT N0. ROAD PERMIT NO. DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK, SEEPAGE-PIT OR PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL - CESSPOOL- DRYWELL WASTE APPROVAL _ SPECIAL CONDITIONS ONLY 2.00 CHARGES CONNECTION CHARGE FEE OWNERS PERMIT 1 00 AUTHORIZATION TOTAL FEE o2 REIMBURSEMENT FEE TRACTORHAVE T TOS CONNECT THEDATE ACTEABODVEWDESCR BED EXITH THE ISTINGNAMED DWELL G APPROVALS DATE INSPECTOR'S SIGNATURE 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) ACDRESS . AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[3 AND STATE,THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY ' WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMB AND SEWERS. .SEWAGE DISPOSAL SYSTEM IHEREBY CERTIFY THAT I AM 'PROPERLY REGISTERED AND/OR ' LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA. OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE $ABANDON HOUSE SEWER -, DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ SEEP.PITS) ElCESSPOOLS.❑ SIGNATURE 1'I�e - }+• �t �'.t� - OF PERMITTEE Cd vvV qu✓° .- WILLIAM J. FOX, COUNTY ENGINEER VALIDATION is "BY BY DEPUTY - DEPUTY ' cy'BY BY DEPUTY t// DEPUTYD 9'