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Home My Public Portal About5715 KAUFFMAN AVE_Sewer__ 76A 642D-CE808-10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING w ADDRESS ®u y AuEr-Ampn 5 i LOCALITYr �j�- FOR APPLICANT TO FILL IN NEAREST iV� /fit CROSS ST. G 4..1 DESCRGPT'0N LOT NO. 56 7 OWNER T_f, -h./ ,� 1If•"�/ MAIL _ BLOCK TRACT � ADDRESS 15- 1-,A 1'! F'f/Fn,d ✓ L NO. OF BLDG S. n TEL. N0. SIZE OF LOT �� 7( / ;) NOW ON LOT CITY'i USE OF DISTRICT NO. GROUP MAP (12SSED BY BUILDINGS BK PG CONTRACTOR ADDRESS S%� j�/f.;J F �I,t,� v ,'� CONNECTIO DATA,s -I�✓' STATION DEPTH CITY Ips e- j! % _ TEL. NO. ~a V STATE LIC MANHOLE REFERENCE �/ UPPER LICENSE NO:: CLASS �.l��j NO. DESCRIPTION OF WORK FEETYPE OFC ION LENGTH FROM HOUSE SEWER CONNECTING TO /� Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $7.00 Cf SEPTIC TANK.SEEPAGE PIT OR CO.IMP. NO. *� JOB NO.P.C.NO, PITS AND/OR DRAINFIELD @ $10.00 /- ��//// HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. I�L�y PRIVATE DISPOSAL SYSTEM @ $3.00 !J! / O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER 'EASEMENT RECORD. INSTR.NO. DATE V WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD IX EXTN..CESSPOOL.DRYWELL. @ $5.00 O ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT V MANHOLE PERMIT NO. d Q $7.00 INDUSTRIAL yhy WASTE APPROVAL b CHARGES OWNERS PERMIT S 3 00�ry AUTHORIZATION TOTAL FEE 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 SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS ^ DAY OF 19_ OWNER OR i NEW HOUSE SEWER ' b ` OWNERS AGE NTL /.liL% .I/% ' _�-.�Yl - T� p^ CONNECT ADDITIONAL ADDRESS •� �' s�,�iJ� P��'� BUILDING OR WORK 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 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSEDAS REOUIRED 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 ABO ESCR E;;ESIDENTJ3L R PERS Y. ABANDON HOUSE SEWER SIGNATURE BACKFILLS T NKS ❑ OF PERMrrTE SEEP.PITfSI p' POOLS ❑ VALIDATION f CK. M.O. CASH 344 10 0 1 0.00A98 r r 76A 642D -CE808- 10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONADDRESSl - /S e ?r,4(j F,1=11,4q' LOCALITY FOR APPLICANT TO FILL IN CROSSSST. LEGAL I f DESCRIPTION LOT NO. OWNER N MAIL / BLOCK TRACT C^ ADDRESS NO. OF BLOTS. r) �� I� DG SIZE OF LOT NOW OIN LOT �( CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP BK MAP PROCESSED BY '- PS CONTRACTOR GtJ A) ADDRESS `>' j CONNECTION DATA H/K `� STATION � f DEPTH CITY '� TEL. NO. STATE LIC MANHOLE REFERENCE /'- UPPER LICENSE NO., CLASS SD q�pW NO. DESCRIPTION OF WORK FEE TYPE OF CO TION LENGTH FFTOM �Y,�-� HOUSE SEWER CONNECTING TO Y. CURB. P.L. M.L.TO P.L. PUBLIC SEWER @ $7.00 1�36 SEPTIC TANK.SEEPAGE PIT OR P.C. NO. PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVED -EASEMENT RECORD.INSTR. NO. DATE O 0 WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL. @ $5.00 O ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ S3.00 STATE ENCROACHMENT V MANHOLE $7PERMIT NO. 141 .00 N INDUSTRIAL yy WASTE APPROVAL b OWNERS PERMIT $ 3 00 CHARGES J AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS Y OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT �� CONNECT ADDITIONAL .A �.r1 I BUILDING OR WORK ADDRESS A �7 .1Y 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 WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS 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 DE IBED RESI EfJTIA PR ERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMfTT SEEP.PIT(S) ElE]CESSPOOLS VALIDATION CK-. M'.0. CASH 4 0OCZAW 61 .0 0 6.00A