HomeMy Public PortalAbout5743 KAUFFMAN AVE_Sewer__ A642D
CEN APPLICA IOFOR PERMIT
ceeoa a-sa COUNTY OF LOS ANGELES B
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING r
ADDRESS
CASSATT D.OHN A. GRIFFIN, Supt ineer
of Building cl
7TEL.
LOCALITY e
NEAREST
CROSS ST.
FOR APPLICANT TO FILL IN _ f�(/
LEGAL —- OWNER ® ®V I
DESCRIPTION LOT NO.
BLOCK TRACT dMAIL iADDRESS NO.OF BLDGS.
SIZE OF LOT CL p NOW ON LOT CITY .
USE OF -
BUILDINGS �p g�/� DISTRICT N0. GROUP BK MAP PG PROCESSED BY
CONTRACTO PARKPLUMBING
G CO. Ildl9oUI
ADDRESS x.10 SO. GARFIELD - AT 2=2604 CONNECTION ATA
CITY MONTEREY PMKO,-CALIFOR STATION DEPTH
v.
❑ STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. I ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK FEE 0Cftt
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF ION ]LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. J 0.
CONNECT ADDITIONAL BLDG.OR ;. TRUNK PERMIT NO. R PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHME
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
r WASTE APP AL
CHARGES
OWNERS PERBOT 2 00 F CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE +D REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HE IN NAMED CON. U
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING r' 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
ADDRESS SEPTIC TANK,SEEP.PIT(S)
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 REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 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 OWN€R OF THE ABOVE
DESCRIBED RESIDENT ROPER BACKFILL SEPTIC TANKS ❑
SIGNATURE ), SEEP. PIT(S) ❑ CESSPOOLS ❑
OF PERMITTEE
OF VALIDATIO . ROBERT A. WOOD
CK. M.o. CASH SUPERVISING MECHANICAL ENGINEER
c