HomeMy Public PortalAbout6208 KAUFFMAN AVE_Sewer__ DEPAIVJVMENT•OF COUNTY ENGINEER 1 SEWER-SEWAGE DISPOSAL 1
` DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY EN13INEER I BUILDING / �� �(r/ �� 'h AV e•
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FOR APP LIC T TO ILL IN LOCALITY / e�/eBUILDING / ;7 NEAREST
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c`1 ADDRESS 1 CROSS ST.
LOCALITY
DISTRICT N0. - SERIAL NO. PERMIT{NO. c
NEAREST Q1� ✓ A /y/(D :.,,���'/ZJ, J
CROSS ST.
^ RECEIVED Y Ready for Inspection, DATE IS8UEQJ�
OWNER
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MAIL USE ZONE OCCUPANCY MAP
ADDRES
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CITY TEL.NO:
CONTRACTOR L D :7, �/ CO.IMP.NO.
ADDRESS � s�+[Lf /�/1 C' r!LL&f CJC�i/T
••.�— JOB N0. �
CITY ,E: p C'/�fEL.NO��1 8'0&* -TRUNK PERMIT NO. -�
// /$TATE '
REGISTRATION'NO. / �7/ /[] COUNTYI ROAD PERMIT NO.LEGAL
DESCRIPTION LOT N0. - ��/(D�6 �y ZI STATE ENCROACHMENT �—
� PERMIT N0.
BLOCK N TRACT AL
INDUSTRIAL
_ WASTE APPROVAL
SIZE OF LOT r.. N0.OF BLDGS.
vv OW ON LOT CHARGES
USE OF
BUILDINGS CONNECT HARGE FEE
NO. DE IPTION•OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 90 RECEIPT N0. D 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- DATE - BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON.SEWER
AND/OR DISPOSAL SYSTEM 1.100 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION 7-)L�/,L
R, I DEPTH
CESSPOOL—DRYWELL I
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFE E ^' l
URPE-R-• •� I /y 0 r-LOWER
TYPE OF CONNECTI LENGTH FROM I
OWNERS
PERMIT ; 1 Y CURB I P.L. ------M.L.TO P.L.
AUTHORIZATION TOTAL FEE 5-0
I 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 7-6/7_f
OWNER OR - - CONNECT ADDITIONAL
OWNERS AGENT....... e ___._-_ ..__._.__......_. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS......_---------------------------------- ...._.........:............................. AND/OR DRAINFIELD
'I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL[] 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
.AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE D RIBED VASIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)[-] CESSPOOLS E]
OF PERMITTEE.
70A042D 663 1/58