HomeMy Public PortalAbout6114 KAUFFMAN AVE_Sewer__ 78A842D
clsaDa a-se APPLICATION FOR PERMIT '
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT-OF COUNTY ENGINEER
BUMDING AND SAFETY DIVISION BUILDING
ADDRESS ,
JOHN A. LAMBIE, County Engineer w!
CASSATT D. GRIFFIN, Supt of Building LOCALITY ,/� 1
_ NEAREST S
FOR AP CANT TO FILL IN ceoSS ST.
LEGAL "'
DESCRIPTION LOT NO. OWNER
JB.L�.00K TRACT.( MAIL
ADDRESS
STT C o�51 NOW ON LOTS / CITY TEL. NO.
USE DI DISTRICT NO. GROUP MAP PROCESSED Y
BUILDINGS I
F - IHK PG
CONTRA p,� (�_ r 4
ADDRESS �' Ir_ CONNECTION DATA
i
CITY TEL.NO. STATION DEPTH
ATE MANHOLE REFERENCE UPPER
REGISTRATION NO.
NO. DESCRIPTION OF WORK FEE -�---
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 7F TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
ITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN. CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. JOB NO.
WORK CT ADDITIONALOUSE BLDG.OR @ g1 00 - TRUNK PERMIT NO. ROAD PERMIT NO.
CIE
ALTER.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTR T WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE A E DESCRIBED E) STING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUwav7SEWER.
SIGNED TH YOF 1 ri+ NEW HOUSE SEWER
OWNER ORWAWCONNECT ADDITIONAL `
OWNERS A BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD -
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR _
PLUMB AND SEWERS. SEWAGE DISPOSAL SYSTEM
f R BY C TIFY THAT AM PROPERL TERED AND/OR DISCONNECT PLUG AND
LICE ED AS EQUIRED BY OS ANGELES OU STAT OF ABANDON HOUSE SEWER
CALI RNIA THAT 1 AM THE LEGAL OW R OF T OVE
DE RI IAL TY. j BACKFILL SEPTIC TANKS ❑ /J
SI T E
SEEP. PIT(5) ❑ CESSPOOLS // ,� 7
OF PERMITTEE-
OF
ERMITTE OF VALIDATION ROBERT A. WOOD
CK. - H.Q. CASH SUPERVISING MECHANICAL ENGINEER
L[C 5.1.5. •JAN 1.4. 1 0 A 5.0,0