HomeMy Public PortalAbout5927 1/4-1/2 KAUFFMAN AVE_Sewer__ f
E608.D
CAPPLICATION FOR PERMIT
eaoe-e-sa COUNTY OF LOS ANGELES .
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION
ADDRESS g �F
JOHN A. LAMBIE, County Engineer
LD I
CASSATT D. GRIFFIN. Supt of Building LOCALITY .
NEAREST
r FOR APPLICANT TO FILL IN ceoss sr.
LEGAL
DESCRIPTION LOT NO. / :)— OWNER
BLOCK TRACT �
/ MAIL
(Q LO ADDRESS
y� / s NO.OF BLDGS.
SIZE OF LOT✓v Y 1 7 5 NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUPMAPROCESSED BY
CONTRACTOR' S f /G�
ADDRESS O L CONNECTION DATA
CITY TEL.N0. STATION DEPTH
REGISTRATION N0. MANHOLE REFERENCE UPPER
NO. DESCRIPTION OF WORK FEE LOWER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONILECTI N LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. / J
CONNECT ADDITIONAL BLDG,OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00 1 00
SEWER OR DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT
PERMIT N0.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 00 REIMBURSEMENT FEE
-.1 I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXI TING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS �9_ NEW HOUSE SEWER
OWNER OR
CONNECT ADDITIONAL ``qq
BUILDING OR WORKr7 ,
OWNERS AGENT `�" �•-R �f%C
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ 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 SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGIST D D/OR DISCONNECT PLUG AND
LICENSED AS ED BY LOS ELES DUN
TY N S TE OF ABANDON HOUSE SEWER
CALIFORNIA TH2m,
I A T G WNE 0 T ABOVE
DESCRIBED ESIDENL E Y BACKFILL SEPTIC
TANKS
[I ❑
SIGNATU E
OF PER ITTE
®P ALMATION ROBERT A.WOOD
cK.
M.0 CASH SUPERVISING MECHANICAL ENGINEER
LACO 1 5 9 3 A AUG 2 4 1 0 A 3.0 0 .