HomeMy Public PortalAbout6036 KAUFFMAN AVE_Sewer__ c I
76A 642D - CE808 - 9/73
APPLICA ON FOR PERMIT ILJI
COUNTY OF LOS ANGELES SEWER-SE AGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING dVQ
ADDRESS h► V
LOCALITY
NEAREST t
FOR APPLICANT TO FILL IN CROSS BT
LEGAL
DESCRIPTION LOT NO OWNER
MAIL
BLOCK TRACT V�.J / ADDRNO. �E.SS O r /
SIZE OF LOT -5 x u�O 0 NOWOON LOT6 CITY (G yVl. /G /'/ TEL NO. � (Q�'O
USE OF
BUILDINGS 42-4 , DISTRICT NO. GROUP BK MAP P3 CESSED BY
CONTRACTOR ��/C-Al ��B z i
ADDRESS , �j g CONNECTION DATA
CITY (T�'(/IA' TEESL. NO. ��p� --7� STATION 66�/v
DEPTH p
STATE CENSE NO, S Q ��` GLASS MANHOLE REFERENCE O L !!. F LOM—
No.
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM L
HOUSE SEWER CONNECTING TO Y. URB P.L. M L TO P.L.
PUBLIC SEWER $7.00
SEPTIC TANK.SEEPAGE PIT OR O P.0 NO.
PITS AND/OR DRAINFIELD @ $10 00 CO.IMP.NO. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM ® S300
CONNECT ADDITIONAL BLDG.OR AFFIDA111[0 [AS[Y[MT RECORD INSTR NO. DATE
WORK TO HOUSE SEWER $3.00 O.
OVERFLOW SEEPAGE PIT,DRAINFIELD - i
EXTN.CESSPOOL.DRYWELL. $500 / C.>HWY.OR ST.WIDEN I NO I=ALTER.REPAIR OR ABANDON HOUSE 1.,,��
SEWER OR DISPOSAL SYSTEM $300 STATE ENCROACHMENT CD
MANHOLE $7.00 PERMIT NO. (~j
® �y
INDUSTRIAL a
WASTE APPROVAL Tn
CHARGES Z
OWNER'S PERMIT s p3 00•
AUTHORIZATION TOTAL FEETU� CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER -�c APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS �� AY O�
OWNER OR ry ', / NEW HOUSE SEWER
OWNERS AGE CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
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 [:1
ID
CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER.REPAIR SEWER OR
'LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM _
CALIF CAR
OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABO RIBED RESIDE IAL PROPERTY ABANDON HOUSE SEWER
SIGNATURE fi,(,�' �,/-`7�///1 L
OF PE-RMTTTE� -�[/ `✓ / //'� ` ' BACKFILSPOOLS ❑
I c
V ATION CK. M.0. CASH
v/
3 4 7 r 1.1An 26 1 0 0 :( V.0 6►�h
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76A 6420 — CE808 — 9/73 APPLICAT 1� FOR PERMIT"
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS /D �
LOCALITY T
NEAREST
FOR APPLICANT TO FILL IN 77 CROSS ST
LEGAL
^ j
SCRIPTION
DELOT NO , ` OWNER �� qf 4,4 '
MAIL,• _ - - ••
BLOCK TRACT S l ADDRESS
NO O
SIZE OF LOT NOW ON LOTS CITY TEL. NO. /- �
USE OF .. I _ _ DISTRICT NO GROUP C /MAP PROCESSED BY
BUILDINGS /�(JJ j BOK �PS Xr
CONTRACTOR/.
ONT RACT OR/� l ^'1� U�` f —I �--/� J1l _
ADDRESS / , / � � CONNECTION DATA-
CITY
ATACITYD7?�,� TEL STATE �QN)O ���c,�--�� � STATION �/ . DEPTH �{
LICENSE NO, �� U / CLL ICASS Gam• MANHOLE REFERENCE 5/•
NO. 1 DESCRIPTION OF WORK FEE TYPE OF CIONbLECTIONLENGTH FROM
HOUSE SEWER CONNECTING TO Y. URB P.L. M.L TOP L
PUBLIC SEWER $7.00
SEPTIC TANK SEEPAGE PIT OR P C.NO.
PITS AND/OR DRAINFIELD $1000 CO IMP.NO. JOB NO
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. ��''^^ C'L
PRIVATE DISPOSAL SYSTEM $300 (./�✓iV
CONNECT ADDITIONAL BL OR AFFIDAVIT WAIVER 1A5[M[KT RECORD"INSTR"NO - DATE
WD.HOUSE SEWER - y i3 00 _� L� a
OVERFLOW SEEPAGE PIT.DRAINFqELD O
EXTN CESSPOOL.RABA DO 55.00 V
ALTER.REPAIR OR ABANDON HOUSE HWY.OR$T.WIDENING
SEWER OR DISPOSAL SYSTEM $3 00O
STATE ENCROACHMENT � �
MANHOLE $7.00 PERMIT NO. V
'^ INDUSTRIAL LJJ
.�/,t�/1 tear y`__i e WASTE APPROVAL f/3
v� ������ J� CHARGES Z
OWNERS PERMIT $ 3 00
AUTHORIZATION TOTAL FEE /� CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON" REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR - NEW HOUSE SEWER
OWNERS AGENT "
,' l CONNECT ADDITIONAL
ADDRESS �C/� �( BUILDING OR WORK - i
SEPTIC TANK SEEP,PIT(S)
IHEREBY 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 ❑ '
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIF C6tNIA OR THAT 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABOVE 1BED RESIDEN PROP TY. ABANDON HOUSE SEWER
SIGNATURE ❑
OF PEQ MiTTEE - BACKFILL SEPTIC TANKS
SEEP.PITS) ESSPOOLS ❑
VALIDATION ICKJ M.0. CASH
5 9 7-MAR �5i i U U 6.0 G ®�ic