HomeMy Public PortalAbout5917 KAUFFMAN AVE_Sewer__ DEPAli.TAENT-OF COUNTY ENGENEER SEWER-SEWAGE DISPOSAL
✓ DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY'OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS / 1
FOR
R AP IC/fA/NTT FI L IN LOCALITYBUILDIN
NEAREST
ADDRESS�� /y• /� CROSS ST.
LOCALITY DISTRICT SERIAL N0. PERMIT N0.
r CNEAREST
ROSS ST.OC+f GI�f�✓ i� A I �� S
RECEIVED
B Y Ready for Inspection DATEISSUED
OWNER
MAIL �� USE ZONE CCUPANCY MAP
` ADDRESS BK PG
CITY ✓/ TELAO.
CONTRACTOR
®Y / CO.IMP.NO. r
ADDRESS �x
JOB N0,
CITY- 1.1 �Al
TELAO, r � TRUNK PERMIT NO.
r
d7 � STATE
REGISTRATION N0. COUNTY ROAD PERMIT N0. �^
LEGALSTATE ENCROACHMENT S
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT .�� INDUSTRIAL -------
WASTE APPROVAL
NO.OF SLOGS.
SIZE OF LOT NOW ON'LO/T CHARGES
BUE DINGS ��/,G��y�6�/USOF
CONNECTION CHARGE FEE u
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO /b
PUBLIC SEWER @ S 3.50 RECEIPT NO. DATE\ I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORD•
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. DATE Y \
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND A
AND/OR DISPOSAL SBYSTEOMN SEWER 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATIAXD�, O DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00- 3A U�' i UROLPPER EFERENCE6R
TYPE OF CONNECrOLENGTH FROM
OWNERS PERMIT $ I 00CuT� P.L M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
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__41..._DAY OF___.l�1d_�_� 19-� NEW HOUSE SEWER
OWNER OR �] - CONNECT ADDITIONAL
OWNERS AGENT. i *Q4 _.._.._ __ BUILDING OR WORK
�• SEPTIC TANK,SEEP.PIT(S)
ADDRESS...`- � _.._.:f.!K !_......... ....................... AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL(] DRYWELL 0
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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AN
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 CRIBED SPSIDIENTIA PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E] CESSPOOLS[:]
SIGNATURE j
OF PERMITTEE..__ .___._
7GA642A 663 7/53
ri'f r
`6Aoe 3-84
78A6420 APPLICATION FOR PERMIT
u
COUNTY OF LOS ANGELES . SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS `1
WILLIAM A. JENSEN, Sup't of Building
LOCALITY '
NEAREST
FOR APPLICANT TO FILL IN CR055 BT l
LEGAL C-`�
DESCRIPTION LOT NO OWNER _
cS6MAIL
BLOCK TRACT I ADDRESS
q� NO OF SLID
SIZE OF LOT b NOW ON LOT CITY - TEL. NO,
USE OF DISTRICT NO. GROUP MAP PROG ED BY
BUILDING > V IJL �- a� BK PG
CONTRACTOR �� D
ADDRESS _ �}` CONNECTION DATA _
� � STATION DEPTH
CITY EL. NO. '^� �I��.L
REGISTRATION NO
/ ALJ STATE COUNTY MANHOLE REFERENCEC(� j UP
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LE GT FROM /
HOUSE SEWER CONNECTING TO Y. CURB P.L. M L T P.L. �+
PUBLIC SEWER $5.00 P.C:NO. r
SEPTIC TANK,SEEPAGE PIT OR CO IMP NO. JOB NO a
PITS AND/OR DRAINFIELD S1000 O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. (,J
PRIVATE DISPOSAL SYSTEM 3300
CONNECT ADDITIONAL BLDG.ORIDAVIT AIVER EASEMENT ECO STR NO DATE ce
WORK TO HOUSE SEWER $300 WO
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CES S POOL.DRYWELL,MANHOLE @ $5 00 FU
BANDON HOUSE HW T. ID UJ
SEWER ) S TEM 83.00 ST ENC CHM N
P vl T N Z
INDUSTRIA
WASTE AP
I a5q
OWNERS PERMIT $ 2 00 C ARGE
AUTHORIZATION TOTAL FEE n 1 CONNECTION CHARGE
1 HAVE 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_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY�ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIAOR M THE LEGAL OWNER OF, AND INT DISCONNECT PLUG AND y
RESIDE IN, TH BOVE D CRIBED R(SIDENTIAL PROPERTY. gNDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TTANKS ❑
OF PERMITTEE SEEP.PIS) ❑ CESSPOOLS ❑
VA IDATION ROBERT A. WOOD
cK M.o CASH SUPERVISING MECHANICAL ENGINEER
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