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Home My Public Portal About5938 KAUFFMAN AVE_Sewer__ r � - °-63 76A642D APPLICA ION FOR P RMIT 6A642 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN. Sup't of Building LOCALITY l� NEAREST FOR APPLICANT TO FILL IN CROSS BT LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT 611ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY )1 L_BK ]]] PG CONTRACTORv F2 ADDRESS w CONNECTION DATA STATION, DEPTH CITY /TJEL N REGISTRATION NO �1 /y �// COUNTY MANHOLE REFERENCE _ LOWER lx/ NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO CURB P L. M L TO P.L a PUBLIC SEWER @ $5 00 ---> SEPTIC TANK,SEEPAGE PIT OR P.C.NO, O PITS AND/OR DRAINFIELD @ $1000 CO.IMP. NO. JOB NO. V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NOQz PRIVATE DISPOSAL SYSTEM @ S300 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVII 145111[NI RECORD INSTR NO. DATE {� WORK TO HOUSE SEWER @ $300 iV• OVERFLOW SEEPAGE PIT,DRAINFIELD l!J EXTN,CESSPOOL,DRYWELL,MANHOLE @ $500 HWY.OR ST.WIDENING N ALTER,REPAIR OR ABANDON HOUSE Z SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s 2 00 CONNECTION CHARGE FEE CHARGES AUTHORIZATION TOTAL FEE ) 1HAVE 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 D TE INSPECTOR'S SIGNATURE n SIGNED THISDAY OF 19_ y r OWNER OR �� NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL / T` ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY 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 CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO ESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS T ❑ OF PERMITTEE SEEP,PIS) ❑ CESSPOOLS ❑ VALIDATIOI�1 ROBERT WOOD l/ /r SUPERVISING MECHANICAL ENGINEER CK M O CASH L O 2 1 8 (BAR L� Z 0 D '7,Q QIT w IC E606 10-63 6A642D L—L•l{,� APPLICATION FOR PERMIT r COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Ea ADDRESS Engineer WILLIAM A. JENSEN, Sup't of Building L OCALiTY NEAREST FOR APPLICANT TO FILL IN CRD55 ST LEGAL DESCRIPTION LOT NO OWNE� MAIL BLOCK TRACT ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY BK PG CONTRACTO � ADORES S YU LjJC "CONNECTION DATA STATION /r C DEPTH ATE MANHOLE REFERENCE REGISTRATION NO COUNTY LOWER NO. DESCRIPTION OF WORK FEE TYPEOF ON NECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y RB P L M1 TOP L PUBLIC SEWER CC $5.00 .0 NO O SEPTIC TANK,SEEPAGE PIT OR CO IMP. O JOB NO. PITS ANO/OR DRAINFIELD @ 51000 V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO. im PRIVATE DISPOSAL SYSTEM @ $3 00 ^ CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIV[R EASr MIOT RECORD INSTR NO DATE G WORK TO HOUSE SEWER @ $300 ^� OVERFLOW SEEPAGE PIT,DRAINFIELD _ W EXTN,CESSPOOL,DRYWELL,MANHOLE @ $5 00 ALTER.REPAIR OR ABANDON HOUSEHWY OR ST WIDENING N SEWER OR DISPOSAL SYSTEM @ 3300 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s 2 00 CHARGES AUTHORIZATION I TOTAL FEE Apo CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WIT THE HEREIN ` MED CON- REIMBURSEMENT FEE - TRACTOR TO CONNECT THE ABOVE DES D XISTI DWELLI G TO THE PUBL IcSFWE97 APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 1 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL T r h ADDRESS BUILDING OR WORK /� �r;�' �'� 1 i`•j _�' SEPTIC TANK.SEEP,PIT(S) ! r I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1HEREBY CERTIFY THA I AM PROPERLY REGISTERED AND/OR ALTER, REPAIR,SEWER OR LICENSED AS REQUIRED Y OS A LES COUNTY AN STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 HE LE AL O ER OF, A INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO ESCR I,BE E N IALR RTY. C' ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS El ❑ SEEP,PIT(S) ❑ CESSPOOLS VALIDAT:C�A "`— ROBERT A. WOOD CK M o, iSH SUPERVISING MECHANICAL ENGINEER LACO 6 1 0 t M 2 1 0 D 5.00- 17 IA ,D_82 7GA642D APPLICATION FOR PERMIT 78A84 ° COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DMSION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN. Sup't of Building ^� LOCALITY NEAREST FOR APPLICANT TO FILL IN CRDSB BT L-GAL DESRIPTION LOT NO OWNER Lam' / q�r MAIL BLOCK TRACT «V ADDRESS NO' OF BLDGS SIZE OF LOT ww O X6T CITY TEL. NO USE OF BUILDINGS DISTRICT NO GROUP MAP PROCES].Y BK PG CONTRACTOR ADDRESS .:CONNECTION DATA CITY TEL NO J/D ST ION DEPTH ��I— ATE MANHOLE REFERENCE REGISTRATION NO LJ COUNTY LOWER d NO DESCRIPTION F WORK FEE TY OF CONN C N LENGTH FROM O HOUSE SEWER CONNECTING TO Y. CU P L, M L TO P.L (� PUBLIC SEWER $5 00 i- SEPTIC TANK,SEEPAGE PIT OR P C.NO. PITS AND/OR DRAINFIELD C $1000 CO IMP NO J- JOB NO O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM 49 5300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE H WORK TO HOUSE SEWER @ $3 00 y OVERFLOW SEEPAGE PIT DRAT FIELD L EXTN,CESSPOOL,DRYW ELL, N OLE @ $5 00 ALTER.REPAIR OR ABA DO USE HWY OR ST.WIDENING SEWER OR POSAL ST @ $300 STATE ENCRO ACHMENT / PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERCHARGESS PERMIT $ AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE ITHAVE AT THIS DATE A CONTRACT WIH 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_ ,rf OWNER ORn�r- NEW HOUSE SEWER OWNERS AGENT !/ r CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY TH T I AM PROPERLY REGISTERED AND/OR ALTER, REPAIR,SEWER OR LICENSED AS REQUIRE BY LOS ANGLES COUNTY A STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT AM THE EGAL OWNER OF, INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB DESCR ED I ENTIAL P ERTY. ABANDON HOUSE SEWER SIGNATURE �F/l BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(s) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK. M o CASH SUPERVISING MECHANICAL ENGINEER JACO 6 2,7 1\ VtAR 5 1 1 0 2 5.0-0- :