HomeMy Public PortalAbout6217 KAUFFMAN AVE_Sewer__ 76A 642D
CE808 8-89 APPLIC ION, FOR PER IVIIT -
7 i
'COUNTY-OF LOS ANGELES SEWER-SEWAOE DISPOSAL ip
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION F-NEARE7.T
1n
• 11-7' �1• -
JOHN A. LAMBIE, County Engineer _
CASSAIT D. GRIFFIN, Supt of Building
FOR APPLICANT TO FILL INn
LEGAL i �-C�/ 1
DESCRIPTION LOT N0. OWNER
- AIL
BLOCK- A I TRACT,j. 4�,�,,Z,a.&�a `� �-t' p DRESS a y'-cs�
SIZE OF LOT I/ ( NOW ON LOTLDGS ]rST�ATION.
Y EL. NO. J'�i " t! �'l-0 •
USE OF
BUILDINGS RICT N0, GROUP MAPROCESSED'BY '
CONTRACTOR
D�
ADDRESS L (-1. . - •CONNECTION DATA
CITY'r TEL.N0. 3,7 q-� ^f DEPTH
❑ STATE MANHOLE REFEREN
REGISTRATION NO. 1 ❑ COUNTY CE 7-r-
� � LOWER
NO. 1 DESCRIPTION OF WORK• FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER
@ $3.00
TYPE _TION' LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR YOF CU. RB P.L. M.L.TO P.L. �J
PITS'AND/OR DRAINFIELD - @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN. CESSPOOL DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO / P.C.N0. '
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. J JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE'SEWER- @ $1.00 Z O o
SEWER OR DAIRO R ABANDON SYSTEM HOUSE @ $1 00 STATE ENCROACHMENTISP -
PERMIT NO.
INDUSTRIAL
'WASTE APPROVAL '
CHARGES
OWNERS PERIUT $ - 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE DO REIMBURSEMENT FEE
I HAVE.AT-THIS.DATE A CONTRACT, WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE' DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS_.o°L._DAY 0174" i9la& NEW HOUSE SEWER
OWNER OR �1 �� CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT,(S)
AND/OR DRAINFIELD - -
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL❑
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 REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY-AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP. PITS) ElCESSPOOLS
OF PERMITTEAM44 pi, -
®� VAIIDATIO ROBERT A. WOOD•
¢B. M.C. CASH E
SUPERVISING MECHANICAL NGINEER
LG5 .y 6 2 HIP 0 7.0, 10- '10