HomeMy Public PortalAbout5943 KAUFFMAN AVE_Sewer__ ceaoe•asoa.oe•ae APPLICATION, FOR PERMIT
- COUNTY OF LOS ANGELES7
SEWER—SE1A/AG-E DISPOSAL" 1.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DWISIONBUILDING s1
JOHN A. LAIE, County Zaginoar' ADDRESS
MB
CASSATS D. GRIFFIN, Supt of Building LOCALITY
NEAREST'•,
FOR APPLICAN TO CROSS ST.
LEGAL.
DESCRIPTION LOT OWNER
BLOCK TRACT MAIL -
ADDRESS
,NO.0 BLDGS.
SIZE OF LOT NOW ON LOT ICITY TEL.N0.
USEF .
BUILDINDI,GS DISTRICT N0. GROUP PG
MAP PROCESSED BY
� `� /-"
CONTRACTOR y'
ADDRES _ 4/ � -
- CONNECTION DATA
CITY
7�' TEL.N0. z Icef STATION �; Q DEPTH
TATE MANHOLE REFERENCE UPPER
REGISTRATION NO. . COUNTY _
No. DESCRIPTION OF WORK FEE _
HOUSE SEWER CONNECTING TO
PUBLIC SEWER (01 $8.00 d
PE OF CONNECTION LENGTH FROM
SEPTIC TANK, SEEPAGE PIT OR Y. TYCURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD $8.00
OVERFLOW SEEPAGE PIT,DRAINFIELD '
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2.00
HOUSE SEWER CONNECTING TO P.C:NO.
PRIVATE DISPOSAL SYSTEM fs-$1.00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER - @•$1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
AER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWLTER OR DISPOSAL SYSTEM 0 $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES .
OWNERS PERM $ Z 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE O p C•�f�
I HAVE-AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE- INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS Jg_ NEwHOUSE SEWER'
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT /7 �� BUILDING OR WORK
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 REGISTERED AND/OR DISCONNECT.PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE-OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER:OF THE ABOVE
DESCRIBED RESIDENT PROPERTY BACKFILL SEPTIC TANKS[I
NATURE SEEP.PITS CESSPOOLS❑
OF PERMITTE
®c /-VALIDATION ROBERTA.WOOD
p� cgyg SUPERVISING MECHANICAL ENGINEER
'.2 7 5 bc'� ,SEP 17 1 a A 5.00 • `r