HomeMy Public PortalAbout5803 KAUFFMAN AVE_Sewer__ r J�
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76A642D APPLICATION FOR PE MIT
78A 642 '•
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A, LAIE. County Engineer ADDRESS
MB
WILLIAM A. JENSEN. Supt of Building__ LOCALITY
NEAREST
FOR APPLICANT TO FILL IN ceoss sr.
LEGALZ
DESCRIPTION LOT NO. OWNER
BLOCK TRACT �� MAIL
ADDRESS 44
O.OF.BfDGS.
SIZE OF LOT D NOW ON LOT CITY TEL. NO
USE OF
BUILDINGS DISTRICT NOI GR—RO�}U•-P MAP PROCES BY
pa
CONTRACTO �' / ?K
ADDRESS CONNECTION DATA
CITY xy
TEL.N0. STATION 3 D ql DEPTH f'
ATE MANHOLE REFERENCE / UPPER
REGISTRATION NO COUNTY
N0. I DESCRI I N OF WORK_ FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 �J7 TYPE OF TON LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CUR P.L. M.h.TO P.L.
PITS AND/OR DRAINFIELD @ S3.00 _
OVERFLOW SEEPAGE PIT,DRAINFIELDry, CL
EXTN..CESSPOOL.DRYWELL @ $2.00 P.C.N0. O
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. D JOB NO. U
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ SLOO TRUNK PERMIT N0. ROAD PERMIT N0. d'
SEWER OR PAIRO R ABANTEN HOUSE @ a1.00 STATE ENCROACHMENT O
PERMIT NO. CJ
INDUSTRIAL LU
CL
WASTE APPROVAL h
CHARGES z
OWNERS PERMIT $ 1 2100 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DTE INSPE�TOR'3 SIGNATURE
TO THE PUBLIC SEWER. II I
SIGNED THIS DA OF 19— NEW HOUSE SEWER
CONNECT ADDITIONAL
WN RSA T BUILDING OR WORK
ADDRES SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT t HAVE EAD 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 SYSTEI# /
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR TH 1 AM THE LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESID L PROP TY. SEEP.PS ❑ CESSPOOLS I r
SIGNATURE
OF PERMITTE
VALIDATION ROBERT X41. WOOD
K.
CY.0. CASA SUPERVISING MECHANICAL ENGINEER
� ;�,7 0 9 1 JAN 16 1 0 D 5.Q Q
0-63
76A642D APPLICATION FOR PERMIT
6A642
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING ,
JOHN A. LAMBIE, County Engineer ADDREss
----- —
WILLIAM A. JENSEN, Sup't of Building
LOCALITY - f
NEAREST
FOR APPLICANT TO FILL IN CRD95 ST. •Y" j : ,'`
LEGAL ,,/'✓p
I DESCRIPTION LOT NO. fy ! OWNER f}
wA, MAIL
BLOCK TRACT • •��f,�' ADDRESS f- �, I r;.l
NO. OF SLOGS. /
SIZE OF LOT NOW ON LOT / CITY TEL. NO.
USE OF
BUILDINGS DISTRICTNO.IGRO UP MAP PROCESSED BY
BK PG
t t
CONTRACTOR }r•j„ rf I f s d .� �!� _ ^..
ADDRESS, yq ;rY,�` :- j - .� CONECTION DATA
STATIONDEPTH
CITY %�; `,�r+' , �+, TEL. NO.,( �i l�f� ;;f ;L i,{'
STATE 11 UPPER
r'� �,,/ / MANHOLE REFERENCE t
` REGISTRATION NO.. �/_„+ 7 COUNTYLQ.wgj ,_ C'
' a
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM _ O
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. `' y;,r V
PUBLIC SEWER (a E5.00 P.C. NO.
SEPTIC JOB NO.
TANK,SEEPAGE PIT OR _ W
PITS AND/OR DRAINFIELD $10.00 CO.IMP. NO. U.
- ';'j
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO,
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL BLDG.OR S AFFIDAVIT I WAIVSA [As....T RECORD. IN5TR.NO. DATE IX
WORK TO HOUSE SEWER 53.00 > Q
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE $5.00 ^
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING" `s. 0
SEWER OR DISPOSAL SYSTEM ® $3.00 STATE ENCROACHMENT
PERMIT NO. llJ
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL 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 - DAY OF 19.ic,l�
OWNER OR �- NEW HOUSE SEWER
OWNERS AGENT y�•17- F ,_, CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK.SEEP,PITS)
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 REGISTEREDAND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
ALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
7 D
ESIDE IN, THE ABOVE] DECRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER
GNATURE ❑
F PERMITTEE 'C'` I.P '' • BACKFILL SEPTIC TANKS
{ SEEP,PITS) ❑ CESSPOOLS ❑
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.0 CASH