HomeMy Public PortalAbout5749 KAUFFMAN AVE_Sewer__ r �DEPAKr1VYENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
~ ` FFVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS na �� P mA�
'5®®7- f�
FOR APPLICANT TO FILL IN LOCALITY
BUILDINGNEAREST a/J
ADDRESS 5-7 �q wP, CROSS ST. awkM 44-
LOCALITYDISTRICI NO. SERIAL NO. PERMITNO.
NEAREST `v' A 42-(0(019 S
CROSS ST. ^� ��
CEIVED BY Ready for Inspection DATE
/ISSUED
OWNER In
MAIL SE ZONE OCCUPANCY MAP
ADDRESS �* e fl 1 Ir, BK PG
CITY / TEL.NO.
CONTRAJ-0RA. 01
CO.IMP.N0.
ADD RESS_rq q I /
JOB N0.
i
CITY TEL.N TRUNK PERMIT NO.
SfATE
REGISTRAT N NO COUNTY ROAD PERMIT NO.LEGAL
DESCRIPTION LOT NO. 1L Lt F1 c TE ENCROACHMENT
f P IT NO.
BLOCK TRACT ��b INDUS
SIZE OF LOT NO.OF BLDGS.
WASTE APPMVAL NOW ON LOT
I CHARGES
USE OF Ilk,
BUILDINGS CONNECTION CHARGE FEE
NO. DESCWIPIIION OF WO FEE
HOUSE SEWER CONNECTING T ��y� REIMBURSEMENT FEE
PUBLIC SEWER !� $ 350 G/i RECEIPT NO. DATEZ�� �BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE BY
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 2.00STATION 24-, DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MMEFERENCE LOVEER
TYPE OFaECT ION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. ( UR P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HERE(N NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
_
SIGNED THIS...... -.---DAY OF.- ....---_-__-....19., , NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.IL.VffE-- -- ------------•---•-•-. _.._.. .... BUILDING OR WORK
��qq SEPTIC TANK,SEEP.PIT(S)
ADDRESS-171j �---.4.-.-� !�.nJX_�_ T-.--. --.-.------_. AND/OR
I HEREBY ACKNOWLEDGE THAT 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE"�;B�OV DE IB RESIDE IePRTY. BACKFILL SEPTIC TANKS� Y�T]T r , SEEP.PIT(S) CESSPOOLS � qi �_�S-jSIGNATOROF PERMI E--------- , ------ v
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6 E•863 12.94
APPLICATION., FOR PERMIT 1
. &
DMSION OF BUMDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of LOS Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRE /�'
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY '/
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER (/�a /y.� r
BLOCK TRACT s MAIL Cly //�9 , ' `—
ADDRESS �) / 7 '7 �11..�/TI -_
NO. OF BLDGS. - U -
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PG
BK
140
CONTRACTOR
ADDRESS : ?T_ yt� CONNECTION DATA f
CITY n A TEL. NO. ,4 r 7 7 STATION DEPTH
❑ STATE MANHOLE REFERENCE
REGISTRATION NO. ❑ 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 CAS $ 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
1 CONNECT ADDITIONAL BLDG. ORNO. JOB. NO.
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT N0. O MIT 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 INDUSTRIA
CESSPOOL- DRYWELL WASTE OPAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVE T TO CON ECTHIS DATE ONTRTHEA ABOVE WDESCR BEDITH THE H EXISTING NAMED
DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER _
NEW HOUSE SEWER I
SIGNED THIS DAY OF 19-
OWNER OR CONNECT ADDITIONAL {t //�, w.�
OWNERS AGENT BUILDING OR WORK ' ..i 0i S e,1 "j
SEPTIC ,ADDRESS AND/ORT DANKRAINFEELDPIT-(S) .
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ �r' � ��
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. - SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES,000NTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
r-
SEEP.-PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITYEE,��'"
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
BY 2.0'0
DEPUTY �/� "' DEPU7Y ,
BY BY ///�
_•-® DEPUTY DEPUTY