HomeMy Public PortalAbout6118 KAUFFMAN AVE_Sewer__ DEPARTB ENT OF COUNTY ENQ3nQ= SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY ERIv9 APPLICATION
OF LOS ANGELES ;
WILLIAM J. FOX, COUNTY ENOINICER I BUILDING ',,/
ADDRESS 1�
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OR APPLICANTUILDING /TIO FILL IN� LOCALITY ?gyp 9e l
ADDRESS i h l / AL NEAREST
CROSS ST.
LOCALITY
NEAREST / DISTRICT N0. III( Ready for Inspection PERMIT NO.
1 I I ' !! S
J
CROSS ST.
_ �1 EIV D BY DATE IS D BY DATE
OWNER /Lyl/Y7 G. r I- I4_�� ��
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MAIL / / USE ZONE OCCUPANCY BK MAP PO
ADDRESS ��(�qg �j
CITY �tly TELAO. e� � le-� , vim. I 6'
CONTRACTOR
CO.IMP.NO..
ADDRESS
JOB NO.
CITY TEL.NO. TRUNK PERMIT NO.
REGISTRATION NO. COUNTY2 D
LEGAL ON F/G p 1 ROAD PERMIT NO..
DESCRIPTION LOT NO, F�rO✓TI ON O�� PERME ENCROACHMENT
BLOCK`1� TRACT ,S�N>�st AnrfA 441VOCa 1 INDUSTRIA
WASTE
APPROVAI.
SIZE OF LOT �� NN0.OF BLDGS.
OW ON LOT / CHARG
USE OF
BUILDINGS �1r B�' ,. R CONNECTION CHARGE FEE
NO. DEScWiFTION OF/,#ORK: F,EE
REIMBURSEMENT FE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.50 RECEIPT NO1 I DATE BY`
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_ WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE I BY -
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR n
PITS AND/OR DRAINFIELD 2.00 STATION -A-+ 7S' DEPTH uX
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 Ss� MAN PPE REFERENCE LOWER
TYPE OF CONNECTIO LENGTH FROM �✓
OWNERS PERMIT ; I 00 ; CURB P.L. M.L.TO P.L.
r
AUTHORIZATION TOTAL FEE 4 19 01
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED+
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING' APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS __.__-DAY OF-..._. 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_.....-.--_ _ BUILDING OR WORK
ADDRESS.--_-•_- .--.-----•--..-----�----_---.._..-_----.---._ SEPTIC TANK.SEEP.PIT(S)_
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL E] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE'
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED,
AjD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(8)� CESSPOOLS[]
OF PERMITTEE .- - - -- - --- - -- --..._.
76A642D S&E 663 4/54