HomeMy Public PortalAbout6202 KAUFFMAN AVE_Sewer__ D
S,&E-689 1,1.59 APPLICATION, FOR PERMIT, - 1
B,&E-8 '
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
: Department of County Engineer
County of,Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS J� C �G6i/sG�O
® CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY C
NEAREST .-
FOR
- -
FOR_APPLIC NT TO' WL CROSS ST.
LEGAL . .,�,,1'- �0'-- "— '
DESCRIPTION--'V^'LOT NO. v OWNER
MAIL
BLOCK TRACT �sy,. ADDRESS- - •-
NO. OF BLDGS - CITY TEL. N0.
SIZE•OF LOT OW ON LOT z
USE OF, DISTRICT NO. - GROUP MAP
BK
BUILDINGS � � .I � � PG
CONTRACTOR '
CONNECTION DATA
ADDRESS �•
rr J
D STATION. DEPTH (p "
CITY TEL. N0. - - •
MANHOLE REFERENCE
STATE LOWER
REGISTRATIO NO.. / Q �L ❑ COUNTY ,
NO -' DESCRIPTIOW 0 ,W RK FEE
HOUSE SEWER CONNECTING TO TYPE OF CTION LENGTH FROM -
Y- RB• P.L. M.L. TO P.L.
PUBLIC SEWER - @ $3.50 Q
SEPTIC TANK,SEEPAGE PIT OR -
PITS AND/OR DRAINFIELD • @.,$3.00 -
OVERFLOW SEEPAGE PIT, DRAINFIELD - -P. C. NO.
EXTN.,CESSPOOL,DRYWE LL,MANHOLE @ $2.00 CO. IMP. N0. / 3 IV—; JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR . STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
•ALTER,REPAIR OR ABANDON HOUSE •INDUSTRIAL _
SEWER OR DISPOSAL SYSTEM -@ -$1.00 WASTE APPROVAL
CHARGES
-CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
'REIMBURSEMENT FEE'
'AUTHORIZATION TOTAL FEE
I HAVE AT'THIS DATE'A CONTRACT WITH THE HEREIN AMED CON= APPROVALS _ DATE INSP.E�7CTORq,SS+IGNATURE
TRACTOR TO CONNECT THE ,ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. - NEW HOUSE SEWER
.3 IGNED THIS, (/ DAY OF 19 S? CONNECT ADDITIONAL
OWNER, OR', _s'Ls/dG ✓✓✓GGG BUILDING OR WORK
OWNERS AGENT 1/ v SEPTIC TANK,SEEP,PIT(S) ,
_ADDRESS 2= V AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE T AT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ '
AND STATE 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-DISPQSAC'SYSTEM
I HEREBY CERTIFY, THAT I 'AM' PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS,REQUIRED BY LOS AgGEL'ES COUNTY AN STA OF ABANDON HOUSESEWER '
CALIFOR RIA OR THATfl AM ILEGAL WNER. HE '
•DESCRIBE_U4d�n SI NTI P BACKFILL SEPTIC TANKS❑-
SEEP. PIT(S) ❑ CESSPOOLS tis
SIGNATU777AAAIll7JJfII///YYY///fff - _
OF PER �E
JOHN'A:LAMB IE..CouNTY ENGINEERVALIDATION ROBERT A. WOOD: CHIEF PLBG. INSPECTOR
CK. hi.0.
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