HomeMy Public PortalAbout5817 KAUFFMAN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING I ADDRESS SE-'/7
FOR APPLICA T FILL IN LOCALITY
ADDREISSl ' fI�AREST Q
OSS ST.
LOCALITY ) g�.- / - _ DISTRICT
CT NO. SERIAL NO. PERMIT NO.
NEAREST /i l / `+ A 35-706
CROSS ST. eiA-4. ( i1 Ate,
RECEIVED 8Y Ready for Inspection J/ DATEnI,{SSUED
OWNER 6 � 9� /d atU
MAIL USE ZONE OCCUPANCY BKS PG
ADDRESS
CITY / TEL.NOy - 1A7'
CONTRACTOR Q CO.IMP.NO.
ADDRES8 _1? JOB.NO.
AA
Y /
CITTEL.NIOO. 7/ f /� TRUNK PERMIT NO.
STATE
REGISTRATION NO. 6) aJ ? 9' sQ COUNTY ROAD PERMIT NO.
LEGAL /� .� r STATE ENCROACHMENT \ O
DESCRIPTION LOT NO. GJ / aJ PERMIT NO.
USTRIAL
BLOCK TRACT WASTE APPROVAL
SIZE OF LOT �� ���� N0.OF BLDGB. CHAR ES
NOW ON LOT
USE OF
BUILDINGS � � � 1 x , �r �1�/it E CONNECTION CHARGE FEE`
NO. DESCRIPTION OF�VYYORK FEE REIMBURSEMENT FEES/ _A
HOUSE SEWER CONNECTING TO \
PUBLICSEWER v @ $ 3.50 RECEIPT N0. I DATE\ I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
/ CONNECT ADDITIONAL BLDG.OR q / / EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING / NO. 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/ORDRAINFIELD 2.00 STATION DEPTH (fJ
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 S MANHOLE REFERENCE
UPPER inwFa
TYPE OF CONNECTION p LENGTH FROM D
-_41iff a- P.L.-,-„ M.L.TO P.L. �� e
OWNERS PERMIT $ L 1 00
AUTHORIZATION TOTAL FEE I S u`� f�'�°'
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECT 'R'S SIGNATURE DATE
DWELLING TO THE PU13LIC SEWER y
SIGNED THIS... DAY OF,..... .. _..19 E NEW HOUSE SEWER
- - -
OWNER OR �n CONNECT ADDITIONAL -
�A. BUILDING OR WORK
OWNERS AGENT. -_•----,_.....--.----._.._..._.__�._,._..-
v ` l_ SEPTIC TANK,SEEP.PIT(S)
ADDRESS__A..._'�"_�., " A��r/!fi � �_ AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I H�VE READ THIS APPLI- CESSPOOL[:] DRYWELL I]
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 HOUSE SEWER
AND
i
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE D CRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
EOF
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