HomeMy Public PortalAbout6210 KAUFFMAN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINIMR SEWER-SEWAGE DISPOSAL,
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
t COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS n
FOR APPLI NTT FILL IN LOCALITY
BUILDING NEAREST :'
ADDRESS CROSS-ST.
LOCALITY DISTRICT NOT. .f - - ,-SERIAL NO.-, PERMIT N0:
NEAREST V A M.) � 9 l/� eq S' S
CROSS ST.
RECE VEDReadDATE ISSUED
OWNER � y for Inspection 7- —s-3
MAIL
ADDRESS USE ZONE ; OCCUPANCY MAP '
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CITYTEL.NO. k�
CONTRACTO CO.IMP.NO. 13 3
ADDRESS `ac ,�Oi JOB.NO.
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CITYTEL.NO TRUNK PERMIT N0. /
STATE /
REGISTRATION N0. COUNTY ROAD PERMIT NO. -
LEGAL , STATE ENCROACHMENT
DESCRIPTION LOT N �D /GOT�s
PERMIT NO.
BLOCK /�l ZLA ��� INDUSTRIAL
w WASTE APPROVAL
SIZE OF LOT N0.OF BLDGS. r
AXI NOW'ON LOT p� ` CHARGES
USE OF
BUILDINGS �� CONNECTION CHARGE FEEV
NO. DE IPTION OF WORK FEE REIMBURSEMENT FEE \
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. - I 'DAI BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 `
CONNECT ADDITIONAL BLDG.OR //,,,�, EXCEPTION RECORDED
WORK"TO-HOUSE SEWER � - 1.00- - •1 �"Cl - I
ALTER OR REPAIR EXISTING 0. I DATE\ I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION D'ATy4
SEPTIC TANK,SEEPAGE PIT OR ,
PIT&AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
`
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
- UPPER LOWER-
TYPE FCONNECTION LENGTH FRbM
OWNERS PERMIT g I -00 Y CURB P.L:- M.L.TO P.L. \'
-AUTHORIZATION TOTAL FEE=
HAVE THIS DATE CONTRACTED WITH THE HEREIN.NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
` -'
SIGNED THIS----•-=-•-----------DAY OF-......-...-.....-•------•---......19..._..-
'NEW HOUSE-SEWER`
OWNER- OR CONNECT ING OR ADDITIONAL. . �A
OWNERS AGENT-•--------------•-------------------.-------------------------------•- - BUIL [nLad.[:c1
ORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS--- ----- .........._..- AND/OR DRAINFIELD
------------- ------ ---------- --..
--•---------------------------- - -
1 HEREBY ACKNOWLEDGE THAT 1-HAVE READ THIS.APPLI- CESSPOOL I]-DRYWELL 1-
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 DISPOSA48YSTEM
1 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 HAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE CRI BE ESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)� CESSPOOLS-
SIGNATURE -
OF PERMITTE ia'f-------_-----.--.-
76A642D 663 1/53