HomeMy Public PortalAbout5746 KAUFFMAN AVE_Sewer__ DEPAKTh ENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
y"L WILLIAM J. FOX. COUNTY ENGINEER �I ADDRESS
FOR APPLICANT TO FILL IN LOCALITY L C 4
BUILDING 7/�/ /I) JNA // NEAREST
CROSS ST. `„1/1
ADDRESSGtifipGjfq
LOCALITY 7- i c DISTRICT NO. A A SERIAL NO. PERMIT NO. C
NEAREST � p,�.sl { J
CROSS ST. ✓f �ia�. R CEIVED BY Ready for Inspection DATE ISSUED
OWNER.414'r r �J-�i� 5
MAIL O` USE ZONET CCCUPANCY MAP
ADDRESS -Cq�.�.eo. V BK P
CITY / L. - TEL.NO. ., ,, .. I •• �.
CONTRACTOR �+� CO.IMP.NO.
ADDRESS �(� JOB NO.
CITY / - TEL.NO0.�� TRUNKPERMITNO. �^
STATE
REGISTRATION NO. gp� ®"COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. ( PERMIT NO.
BLOCK TRACT <7 INDUSTRIAL
_ WASTE APPROVAL
SIZE OF LOTNO OF BLDGS.
I O dd X Z� C�1 NDW ON LOT CHARGES
OF
BUIELDINGS }� u lo \ 1 Y�_G �"o( CONN ON CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT
PUBLICSEWER @ $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
/ CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORD
/ WORK TO HOUSE SEWER 1.00' O N0.
ALTER OR REPAIR EXISTING I DATE I B
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER --�
.AND/OR DISPOSAL SYSTEM 1.00 ONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 STATION PTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 LE REFERENCE
UPPER LOWER
T -CONNECTION LENGTH FROM
Y. CURB P L: M.L.TO P.L.
.OWNERS PERMIT $ I 00
AUTHORIZATION TOTAL FEE Z Gca
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING '-APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS__._.._._.___.D Y 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 1 HAVE READ THIS APPLI. CESSPOOL❑ DRYWELL❑ -
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE'
TO COMPLY WITH ALL COUNTY-ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- -
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROP. BACKFILL SEPTIC TANKS El-
-I.-
•
SIGNATURE SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE.]- —L" 'A - - - - -
76A642A 663 7/53
DEPARTMENT OF COUNTY ENGINFIM SEWER—SEWAGE DISPOSAL. 1
ys ,,,_DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS 7 Vb
FOR APPLICANT TP, FILL IN LOCALITY 777
BUILDINGNEAREST �J
ADDRESS l/ CROSS ST.
LOCALITY DISTRICT NO t SERIAL NO. PERMIT
{pNO.
NEAREST //1V v��
CROSS ST. —'
REC IVE B Ready for Inspection DA E ISSUII
OWNER
MAIL G USE ZO OCCUPANCY MAP ADDRESS %n _ PG
CITY( TEL.NO, ( BK
CONTRACTOR CO.IMP.N0. Z�
. I 1 ie Itv
ADDRESS 5933 N C6QV&RI_rnVr---
JOB.N0.
CITY TEMPIMLO ., CALIF. TRUNK PERMIT NO.
� TATE
REGISTRATION NO. - / ®COUNTY, ROAD PERMIT NO.
LEGALSTATE ENCROACHMENT
DESCRIPTION LOT NO. -67 / PERMIT NO.
BLOCK TRACT a (D! INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT Q JC G NO.W OOF N LOBLOTGS. CHARGE 3 i
NO
USE
BUILDINGS J� CONNECTION CHARGE E
.(/
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION R C
N0. ORDED
WORK TO HOUSE SEWER 1.00 O1
ALTER OR REPAIR EXISTING / DATE IBY
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, 1-74- 71, Z DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00MAN EFERENC
, PP / SER
TYPE OF C ECTIONqtr LENGTH FROM rj
OWNERS PERMIT $ I I 00 RBj M.L.TO P.L. G
AUTHORIZATION I TOTAL FEE I d,
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED,EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS...._ _ AY O -19 NEW HOUSE SEWER .p .,,�, f �i° 14
OWNER OR CONNECT ADDITIONAL
OWNERS AGEN BUILDING OR WORK
- :j--._.. - ti. _. ._:�._
SEPTIC TANKSEEP.
ADDRESS.... _��Jl-@:_. _.` _.._ _...�i AND/OR DRAINFIELD ITS)
1 HEREBY ACKNOWLEDGE THAT I NAVE BEAD THIS APPLI- CESSPOOL I-] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREEI
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. I SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED: DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY'
AND STATE OF CALIFORNIA OR THAT I AMT E LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABO SR{QE MPERTY. BACKFILL SEPTIC TANKS(] ,
N, 1 SEEP.PIT(S)E] CESSPOOLS 0,9
SIGNATURE 1
OF PERMITTEE - ----- -• - --- - ----------I---------------_....---
76A642A 663 7/53