HomeMy Public PortalAbout5833 KAUFFMAN AVE_Sewer__ DEPAK11vIENT'OF 001U1vTY ENGINEER SEVER-SEWAGE DISPOSAL 1
DIVISION- OF BUILDING AND SAFETY ! PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAMJ. FOX, COUNTY ENGINEER 'ADDRESS 533 �� 1� a V �•Y1a� I
FOR APPLICANT FILL JN LOCALITY-T7 c-
BUILDINGNEAREST -7q �A CRO888T. ( ~
ADDRESS ®i 'w
LOCALITY DISTRICT NO.
A- .SERIAL N0: PERMIT NO. c
NEAREST S A t 1 'CGj S
CROSS ST.
ECEIVIED
BY Ready for InsDeetlso ..DATE ISSUED
OWNER
MAIL
ADDRESS USE ZONE OCCUPANCY BK MAP PG
CITY TEL.NO. �Z2,
CONTRACTOR
CO.IMP.NO. I �tJJ
ADDRESS JJOB NO.
py 1
CITY �A TEL.NO. '•/4/ /' TRUNK PERMIT NO. _—
STATE
REGISTRATION N0, H COUNTY ROAD PERMIT NO.
LEGAL �+ 1 Lq
DESCRIPTION LOT,NO., e� I' o STATE ENCROACHMENT, •
PERMIT NO.
BLOCK TRACT 5� ) INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 5� X I -7.S' NOW ON LOTS CHARGES
USE OF' - � -- - _ - - - -
BUILDINGS CONNECTIO ARGE FEE
NO. DESCRIPTION ❑F-WORK
FEE
HOUSE SEWER CONNECTING'TO REIMBURSEMENT FE
PUBLICSEWER $ 3.50 ~ C7 RECEIPT NO. ATE I BY
HOUSE SEWER CONNECTING'TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORD
WORK TO HOUSE SEWER i.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 2.00 STATION 2 4C3"f7 DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 Q_ O� 1 F REFERENCE
TYPE OF CONNECT[O�PPER� LENGTH FROM /
OWNERS PERMIT I pp P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE C� 6- �
10 `�-�Ai�s
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....-....`_--..-DAY OF.=.....____.__._._..._I9__ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL F
OWNERS AGENT-------------------------------.------------------------------------------- BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(8)
ADDRESS------------------------
------------------------------------------------ AHD/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL Ej DRYWELL 1:1CATION 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 I AM PROPERLY REGISTERED AND
DISCONNECT USE PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWNSEWER
-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS 7�
SEEP.PIT(S)[] CESSPOOLS
SIGNATURE - ......OF PERMITTEE-.-
_ 76A642D 663 1/53