HomeMy Public PortalAbout6044 1/2 KAUFFMAN AVE_Sewer__ CE808-C APPLICATION FOR PERMIT
ceaoe-•-ss COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Sup't of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. E r
LEGAL OWNER
' DESCRIPTION LOT N0. � - r �j
BLOCK TRACT f MAIL
ADDRESS
7 N0.OF BLDGS.
SIZE OF LOT,., , -' �* 4% NOW ON LOT rti CITY r TEL. N0.
USE OF
BUILDINGS DISTRICT NO, GROU,. BK MAP PG PROCESSED BY
CONTRACTOR '__
ADDRESS r a.f :-" - r_ CONNECTION DATA
CITY,/1',,'j, TEL. NO. STATION DEPTH
REGISTRATION NO. ` f,�?�. f 1� �. SCTATEOUNTY MANHOLE REFERENCE UPPER
LJ
No. DESCRIPTIONOF WORK FEE _ LOWER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK, SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD .,,..;,..-
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 -
HOUSE SEWER CONNECTING TO P.C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. JOB NO.
CONNECT ADDITIONAL-BLDG.O$f.
ORK TO HOUSE SEWER TRUNK PERMIT N0. ROAD PERMIT N0.
W - , @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
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-DAY OF _ I NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT_.__ � _ - ' "`� 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 [I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I 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 1 AM TYPE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. , BACKFILL SEPTIC TANKS ❑
i t,.
SIGNATURE1 4-
SEEP. PIT(S) E] CESSPOOLS [:1
OF
,' }.:r !r
OF PERMITTEE
OF VALIDATION ROBERT A.WOOD
CK. N.0. CASH SUPERVISING MECHANICAL ENGINEER