HomeMy Public PortalAbout6138 KAUFFMAN AVE_Sewer__ 76AG420 APPLICATION FOR PERMIT -
fi.883 11-55
DIVISION OF BUILDING AND SAFETY SEWER-SEWA , D ISPOSAL 1
Depoitment of County Engineer
County of Los Angeles BUILDING - -
JOHN A. LAMBIE, COUNTY,ENGINEER ADDRESS o (J
® CASSATT D. GRIFFIN, SUPT OF BUILDING - LOCALITY pP, cvv4 64 --
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL t 1
DESCRIPTION_ 0 NO.' f b� OWNER
Q O O MAIL
B CKZ - TFfACTADDRESS
NO. OF BLDGS. CITY TEL. N0.
SIZE OF LOT NOW ON LOT -
USE OF
BUILDINGS - DISTRICT-NO. GROUP MAP
BK PG
-CONTRACTOR �
74r
ADDRESS Itld CONNECTION DATA '
STATION DEPTH /
CITY TEL. NO. �- F.MANHOLE REFERENCE
�j ❑ STATEOWER
REGISTRATION N0: •/ ,,Q'�� ®++C�'t?1fR'i .
No. DESCRIPTION OF WORK FEE TYPE OF CTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURB M.L. TO P.L.'-
PUBLIC SEWER @ $3.50 _
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00 r P. C. NO. '
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO f J�
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT N0. ROAD.PERMIT N0.
CONNECT ADDITIONAL BLDG.ORISTATE ENCROACHMENT -
WORK TO HOUSE SEWER @ $1.00 D PERMIT NO. - -
ALTER,REPAIR OR_ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE -
OWNERS PERMIT g 1 00
D REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE '
,I HAVE AT THIS DATE A ONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE'
TRACTOR TO CONNECT- T E ABOVE DES ]BED EXISTING DWELLING
TO THE PUBLIC 5E,�N ER NEW HOUSE SEWER -`ZCAeZ"5h7` -a f a'
SIGNED.THIS DAY OF 179T CONNECT ADDITIONAL .
OWNER OR BUILDING OR WORK - -
OWNERS AGE �EPTIC TANK,SEEP, PIT(S) -
ADDRESS - AND/OR DRAINFIELD -
1 HEREB ACKNOWLEDGE THAT I HAVE*READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND ST THAT,THE ABOVE IS CORRECT AND AGREE TO COMPLY
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 R ISTERED AND/OR DISCONNECT PLUG AND
LICENSED'AS REQUIRED BY LOS ANGELES Y AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LE L R F THE ABOVE
DESCRIBED RESIDEN PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS
OF PERMITTEE '
JOHN A. LAM E, COUNT EER, VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M. 0. CASH
�X0I3 JUL .•.J ' 4 5.50
3?-3
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