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Home My Public Portal About6044 KAUFFMAN AVE_Sewer__ ` _82 78AAG42D842D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS QLD WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL // ! DESCRIPTION LOT NO!St 4O ® OWNE �7r MAIL BLOCK TRACT �V / ADDRESS 1® BLDG SIZE OF LOT ^" NOWOON L TV� J1 CITY f TEL. NO USE OF BUILDINGS STRIC NO. GR MAP PROCESSED BY BK PG CONTRACTOR ADDRESS. ;0 CONNECTION DATA CITY TEL C STATION DEPTH STATE MANHOLE REFERENCE �� REGISTRA ON NO D ❑ COUNTY LOWER d NO DESCRIPTION F WORK FEE TYPE OF C EC ION LENGTH FROM O HOUSE SEWER CONNECTING TO Y. CURB P.L M L TO P L U PUBLIC SEWER @ $5 00 IIX SEPTIC TANK,SEEPAGE PIT OR P.C.NO. PITS ANDOR DRAINFIELD @ $1000 CO.IMP.NO. J .108 NO y`0 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO 0 �J PRIVATE DISPOSAL SYSTEM @ $3.00 • tJJ CONNECT ADDITIONAL BLDG OR `L ,, =W.11 [ASEMEHT RECORD INSTR NO DATE a { WORK TO HOUSE SEWER @ $300 G�IJ N OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN,CESSPOOL,DRYWELL,MA NHOLE @ S5.00 HWY OR ST WIDENING ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO. INDUSTRI AlL i WASTE APPROVAL OWNERS PERMIT $ 2 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE CH1 I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT T E ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SE — APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS AY O �-S OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK P '`� ♦� ADDRESS SEPTIC TANK.SEEP,PIT(S) WL ` 1 HEREBY ACKNOWLEDGE T AT I H READ THIS APPLICATION AN./OR DRAINFIELD i AND STATE THAT THE ABOVE IS CO AND AGREE TO COMPLY . WITH ALL COUNTY ORDINANCES A TATE 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 /J ' CALIFORNIA OR THAT AM LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND J RESIDE IN. THE ABO SCRIBED IDE TIAL ROPERTY. ABANDON HOUSE SEWER / SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTE SEEP.PIT(S) ❑ CESSPOOLS VALIDATION ROBEAT A. WOOD SUPERVISING MECHANICAL ENGINEER CK M O. CASH J/ u o 6, 3 8 FEB 8 1 0. D 1 3.0 G ceaDa 10.62 76asazD APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPO AL DEPARTMENT OF COUNTY ENGINEER BUILDING,AND SAFETY.,DIVISION. BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building j LOCALITY 1 NEAREST FOR APPLICANT TO FILL IN CRDSS ST LEGAL DESCRIPTION LOT NO OWNER. MAIL BLOCK TRACT ADDRESS NO OF BLDGS. SIZE OF LOT NOW ON LOT CITY L. NO. USE OF BUILDINGS DISTRICnGMAP PROCESSED BYB LSPG CONTRACTOR ADDRESS CONNECTION DATA CITY TEL NO STATION DEPTH ' ❑ STATE MAN �� UPPER REGISTRATION NO -• - - El COUNTY HO REFERENCE LOWER ` NO DESCRIPTION OF WORK FEE -TYPE OF NNECTION �rL5ENGTH FROM HOUSE SEWER CONNECTING TO Y C PL M.L TOP L ��JJ PUBLIC SEWER @ $5 00 SEPTIC TANK.SEEPAGE PIT OR PC NO V PITS AND/OR DRAINFIELD _ C 31000 CO.IMP NO JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT ROAO PRIVATE DISPOSAL SYSTEM @ $300 CONNECT ADDITIONAL 8�}! /yv AFFIDAVI WAIVER EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.CESSPOOL,DRYWELL,MANHOLE @ $500 HWY OR ST WIDENING ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISP SAL S TEM @ $300 - - STATE ENCROACHMENT / PERMIT NO _ - INDUSTRIAL - WASTE APPROVAL WNER'$ PERMIT -$ z 00 CHARGES 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 DESCRI ED EXISTING DWELLING, _ TO THE PUBLIC S WERAPPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DA_ Y OF 1 - OWNER OR - NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) I I HEREBY ACKNO LEDGE THAT I READ THIS APPLICATION AND/OR DRAINFIELD _ AND STATE THAT THE ABOVE IS CO CT AND AGREE-TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ - IHEREBY 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/ AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE' IN,' THE'ABO`EDES1CRISED RE DENT PR PERTY ` ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS ❑ - ' SEEP,PIT(S) ElCESSPOOLS 0 VALIDATION ROBERT A. WOOD CK M O' SUPERVISING MECHANICAL ENGINEER Y - CASH 9 7 0 .1 JUL 2C 1 0 Q