HomeMy Public PortalAbout6023 KAUFFMAN AVE_Sewer__ DEPARZ`AfENT. OF-COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
•DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES A
WILLIAM J. FOX, COUNTY ENGINEER BUILDING ry
ADDRESS
NEAREST
002 TO FILL IN 1 LOCALITY _7_17C
ADDRESSBUILDING 0LJo( 2� CROSS ST.
LOCALITY rp DISTRICT�N0. SERIAL NO. PERMIT NO, c
NEAREST I r { A O�(��+ S
CROSS ST. W
i REED BY Ready for Inspection �DATUED
OWNER 0(�
MAIL USE ZONE OCC PAN MAR
ADDRESS BK�+J'/��1 /J Pr
CITYTEL.NO. I3f
CONTRACTOR .. CO.IMP.NO. V
ADDRESS .JOB.NO.
CITY TEL.NO. `TRUNK PERMIT N0.
�j STATE az .35
REGISTRATION N0. 6! COUNTY ..ROAD PERMIT NO.
LEGAL ® STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT S INDUSTRIAL
�— WASTE APPROVAL
SIZE OF LOTS'b X NO.OF BLDGS. CHARGES.
NOW ON LOT „_
USE OF
BUILDING8CONNECTION&HARGE FEE
NO. DESCRIPTION OF WCJR#e FEE REIMBURSEMENT F E-
HOUSE SEWER CONNECTING T
PUBLIC SEWER Q $ 3.50 Mr - RECEIPT N0. Irl �AFE BY
HOUSE SEWER CONNECTING TO �"'
PRIVATE DISPOSAL SYSTEM 1.00 y
CONNECT ADDITIONAL BLDG.OR �P EXCEPTION RECORDED `yam
WORK TO HOUSE SEWER_ 1.00
ALTER OR REPAIR EXISTING NO. I DATE I BY �_��
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE
PITS AND/OR DRAINFIIELDT OR 2.00 I STATION j� DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 12.00 I ��� MANHOLE
OER REFERENCEUPPtomtm
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 1 00 CURB 1171r.— M.L.TO P.L.
AUTHORIZATION I TOTAL FEEI`HAVE DATE
NAED
CO TRA TOIR TO CONNECT THTE ED A W ITH VE D SCRIBEDTHEI EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC $EWE
t NEW HOUSE SEWER
SIGNED THIS...... ..........DAY OF__ _._._..19,N
OWNER OR, �T CONNECT ADDITIONAL
BUILDING OR WORK _x..
OWNERS NT - -- -- - ------ -------•------•---- -
SEPTIC TANK,SEEP.PIT(S)
ADDRESS. __ . .. .. ....... ......... __.._-_-.___ AND/OR DRAINFIELD
I HEREBY AC 0. LEDGE THAT 1 HAVE READ HIS APPLI- CESSPOOL(] DRYWELL I
CATION AND STATE THAT THE ABOVE IS COR RECND AGREE `•• `,
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR 1�j `P-,l
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM y �b
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I SM THE LEGAL OWN-
ER OF THE ABOVE DPCRIBIED RE$IDEATIAL PROPERTY. BACKFILL SEPTIC TANKS /
SIGNATURE SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE
76A642D 663 1/53 J$