HomeMy Public PortalAbout6127 KAUFFMAN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF .BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGADDINEER BUILREDING \�
1 I SS Tu�.la 'Y YC1t�1.t�
FOR APPLICANT TO FILL IN LOCALIT-Y"—'� L
BUILDING ` �� /� �� /� `�G NEAREST I
ADDRESS �' �(,' /��� ry /J� CROSS ST. %
LOCALITY ✓�/�/��•/ } DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST I I�`7./a/J A `9 7) S
CROSS ST. a� R CEIVED BY Ready for Inspection DATE ISSUED
OWNER ti el�rJ ,. I s 1-Z--0
MAILj!jUSE ZO OCCUPANCY MAP
ADDRESS
- ,./�s'rL�rcx BK PG
CITY ` _ ✓ TEL,NO. ..
CONTRACTOR CO.IMP.NO. , 1
ADDRESS � L JOB NO.
CITY TEL.NOO.//�) �'6 TRUNK PERMIT NO.
or
REGISTRATION NO. ® COUNTTTYj ROAD PERMIT NO.LEGAL h
DESCRIPTION LOT NOF_4tr-QWb W ,� ��7/ PTATE ERMIT NOROACHMENT
BLOCK A� TRACTS j;0 ,4zA)_ ldit� .4! INDUSTRIAL
� WASTE APPROVAL
SIZE OF LOT'/lr NO.OF BLDGS.
�t-/X/4 �J NOW ON LOT CHARGES
USE OF g �j / I
BUILDINGS ��!`/Csi:G,W//1✓C^ CONNECTIOiI`ARGEFEE
NO. DESCRIPTION OF-'WORK FEE �-
HOUSE SEWER CONNECTING TO ` REIMBURSEMENT FEE--.,,
PUBLICSEWER @ $ 3.50 �I RECEIPT NO. I BY
—I HOUSE SEWER CONNECTING TO f
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLD6.OR EXCEPTION RECORDED`
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE ( BY
SEWER OR DISPOSAL SYSTEM 1.00
-DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION .¢.'� DEPTH
CESSPOOL-0 RYW ELL
fiPEC1AL CONDITIONS ONLY 2.00 �e�, MA-UPORLE�REFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT I 00
—Y. C"& --Qpa,,,,, M.L.TOsC,"& M.L.TO P.L. �
AUTHORIZATION I TOTAL FEE + s-z
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER /
NEW HOUSE SEWER
SIGNED THIS SAY OF. ___._______,________.__.19...__ G�1 G �-
OWNER OR CONNECT ADDITIONAL
�P BUILDING OR WORK
i�OWNERS AG T_+..___r.__. -_•.-- _
ly SEPTIC TANK,SEEP.PIT(S)
ADDRESS.- _` ._____..._ :.._.._...__._...-----.----._.......___... AND/ORORAINFIELD
I HEREBY ACKNOWLEDGE THAT I AVE READ THIS APPLI- CESSPOOL DRYWELL
CATH [:]IONAND 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIF RNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE`D �fitt�
S SIDENTIAL PR`O,PPqTY. BACKFILL SEPTIC TANKSE]
SIGNATURE ! _ ��u` SEEP.PIT(S) CESSPOOLB
OF PERMITTEE_-_' __ —___'^'�___ / _
76A642A 663 7/53