HomeMy Public PortalAbout6027 KAUFFMAN AVE_Sewer__ S&E•863 11-55
DIVISION OF BUILDING AM SAFETY S F-W g RAS EWAG E D 8 S P®SA L
Department of County Engineer
County of Los Angeles eUiLDING <r le
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESSCASSATT D. GRIFFIN SUPT OF BUILDING � LOCALITY.NEAREST7OR APPLICANT TO PILL I1V CROSS ST. JDES GAPTION A TNO p"/ r OWNERBLOCK TRACTADDRESS J •./�, N0. OF BLDGS. �SLZE OF LOT J�•% 9 S/ NOW ON LOT CITY PTEL. NO.
USE OF
e. BUILDINGS ,,1��4A ALS-( �+'` DISTRICTS NO. GROUP yn Yf,MAP
PG
CONTRACTOR _ C�� y 5, 0,�
A DURESS 4 l CONNECTION DATA
.7L . lie
Y CITY TEL. NO.� STATION .. B' DEPTH
,
MANHOLE REFERENCE
❑ STATE �,/ LOWER
REGISTRATION NO. 0 x„999 ❑ COUNTY
No. DESCRIPTI N OF WORK FEE
HOUSE SEWER CONNECTING TOt< TYPE OF TION 'LENGTH FROM
PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $ 3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD � P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT N0. 06
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERM.4T NO.
ALTER,REPAIR OR ABANDON HOUSE - INDUSTRIAL � •
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE.APPROVAL
CHARGES
t .
CONNECTION CHARGE FEE.
OWNER'SPERMIT t 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEEL
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MEDCON- APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. �'_ f� ., ,� NEW HOUSE SEWER
SIGNED THIS W. DAY OF 9-/�' ��'a� 19
-� BUILDING OR WORK
AL
OWNERS AGENT OWNER OR �' "�0
SEPTIC TANK,SEEP,PIT(S)
ADDRESS--Lr AN
D/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
° WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR.
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1ICHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEIjTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE nQ �s SEEP. PIT(S) ❑ CESSPOOLS C,ter&
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.l0�. CAS o� V�^['p oq
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