HomeMy Public PortalAbout5923 KAUFFMAN AVE_Sewer__ S8&E-6a69 11.88 APPLICATION FOR PER-MIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL 1
Department of County Engineer
County of LOS•Angeles BUILDING -
JOHN A. LAMBIE. COUNTY ENGINEER I NEAREST
ADDRESS
® CASSATT D. GRIFFIN, SUPT of BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGALJ j, -5, OWNER
DESCRIPTION LOT N0. G-,
MAIL - - -
BLOCK TRACT / ADDRESS '
NO. OF BLDGS. _
SIZE OF LOT CITY TEL. N0.NOW ON LOT L
USE OF •DISTRICT NO. GROUP MAP
BUILDINGS MA
BK PG
CONTRACTOR
ADDRESS CONNECTIONS DATA
r
STATION L- DEPTH
'CITY TEL. N0. ,� UPPER
MANHOLE REFERENCE
REGISTRATION NO. `� �Q/'��/ ❑ COU LOWER
TY
NO. DESCRIPTION OF WdRI( FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L. TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELDP. C. N0. '
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. N0. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $-1.00 TRUNK PERMIT NO. - ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 '" PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL '-
CHARGES
CONNECTION CHARGE FEE
OWNER'S PEST 1 Oo '
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE..
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS_ DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. - NEW HOUSE SEWER _
SIGNED THIS—DAY OF 1 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK.
OWNERS AGENT
SEPTIC TANK,SEEP,PIT(S)
ADDRESS 4. AND/OR DRAINFIELD
I HEREBY CKNOWLEDGE HAT I HAV AD THIS APPLICATION CESSPOOL❑ DRYWELL�
AND STATE THAT THE ABOVE IS CORR AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS EOUIRED EjY LOS ANGELES C UNTY D STATE ABANDON HOUSE SEWER -
CALIFORNIA 0 THA AM LEGAL NER' T _
14CED R ROP BACKFILL SEPTIC TANKS❑
URS` SEEP PIT(S) ❑ CESSPOOLS❑
PERMIT EE
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JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF-PLBG. INSPECTOR
• CK. H. 0. ASH - - -
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6 - APPLICATION FOR PE.FiMIT cSf1�23- '
a,8DIVISION OF BUILDING AND SAFETY SEWERSEWAGEDISPOSAL
Dep=bment of Couniy Engineer
' County of Los Angeles - 'BUILDING
_ JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS -
® ' CASSATT,D GRIFFIN, SUPT-OF BUILDING LOCALITY "
FOR-APPLICANT TO -FILL IN CROSS ST.
LEGAL, -
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
/ .S `ADDRESS
NO. OF BLDGS. CITY TEL. NO.
SIZE OF LOT - NOW ON'LOT
USE OF DISTRICT NO. - GROUP MAP
BUILDINGS
�°.BK PG
CONTRACTOR -
CONNECTION DATA
ADDRESS 140qlze h" 1/114 AQi�
STATION DEPTH ,
CITYAA TEL. NO. 04 rnj,�73/,W/ _MANHOLE REFERENCE
STATE LOWER
REGISTRATION N0. ❑ COUNTY NO. DESCRIPTION O WORK FEE TYPE OF CONNECTIO LENGTH FROM - !'
HOUSE SEWER CONNECTING TO Y. CURB P.L. , M.L.TO P.L.
PUBLIC SEWER @ $3.50
_ SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD - - - P. C. NO. '
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2.00 _ CO. IMP. NO. �'Sj' � JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT.NO. ROAD PERMIT NO.'�
CONNECT ADDITIONAL BLDG.OR. - STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL '
CHARGES
• 'CONNECTION'CHARGE FEE
OWNER'S PERMIT 1 00 °
REIMBURSEMENT FEE - -
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE-
TRACTOR TOCONNE T ABOVE DESCRIBED EXISTING DWELLING /
TO THE PUBLIC SEW _ NEW HOUSE SEWER
SIGNED THIS DAY OF 15 � CONNECT.ADDITIONAL '
OWNER OR' . -�� '� BUILDING OR WORK - - - -
OWNERS AGENT
SEPTIC TANK,SEEP;PIT(S) _
ADDRESS AND/OR DRAINFIELD •- - '
1 HEREBY ACKNOWLEDGE H AT AVE READ HIS APPLICATION CESSPOOL❑ DRYWELL❑ - -
AND STATE THAT THE ABOVE I RECT 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED'BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND
*Cg
FORNI OR THATt I AM THE LEG OWNS OF HE V
WER
ED I AL P RTY. • BACKFILL SEPTIC TANKS❑� DI• / i _SEEP PIT(S) ❑ CESSPOOLS
OF PERMIT EE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. N O CtASH
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