HomeMy Public PortalAbout6218 KAUFFMAN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEE_R. -SEWER-SEWAGE DISPOSAL 1
'DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
®� COUNTY OF LOS ANGELES
WILLIAM J. FOXY COUNTY ENGINEER - BUILDING � 21al, v
ADDRESS
FOR APPLICANT TO FILL IN LOCALITYBUILDING
NEAREST
ADDRESS ��L /G — / �+-.. CROSS ST. zez'lv�„[��i�'�
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A �D�J S
CROSS ST.
OWNER � RECEIVED B Ready for Inspection DArt�E ISSUED
f" �
-_ M s°% /,�"�t�'` � - G,�
MAIL l i
ADDRESS�j USE ZONE OCCUPANCY BK MAP PG
CITY TELAO. /1� / I /��,s I e::� -7,:5-
CONTRACTOR fA 0 �q„ G.�+'�� , CO.IMP.NO. `� C
ADDRESS
}� JOB.NO.
CITY TEL_ . ►t- I/ TRUNK PERMIT NO.
REGISTRATION NO. STATE
�•3�� � �+ COUNTY ROAD PERMIT NO. �� 3
LEGAL STATE ENCROACHMENT d/
DESCRIPTION LOT N0. 5 2 7-/V Z0S� PERMIT N0.
BLOCK TRACT 01 4 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT i NO.0 BLDGS.
X NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE PUBL CSEWER EWER�NNECTING TO @ $ 3.50 RECEIPT NO. �I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM I.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,
_ PTS AND/OR RA NFIGELDTOR 2.00 I STATION7�s DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 /' MANUPPER EFERENCE C L�W£R'
r TYPE OF NECTIO LENGTH FROM
OWNERS PERMIT $ $ 00 Y, CURP>r -tet- M.L.TO P.L. ��
AUTHORIZATION .1 TOTAL FEE
1 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...0, ._...___.____._..19��'{ NEW HOUSE SEWER`
OWNER OR CONNECT ADDITIONAL
OWNERS ADEN BUILDING OR WORK
- - •-- -----------
SEPTIC TANK,SEEP.PIT(S)
ADDRESSS... _. __ _-.�_ :. AND/OR DRAINFIELD
I HEREBY ACKNOWL DBE THAT I HAVE READ THIS L CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGR
TO C0 PLY,WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED' DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS AN ELES COUNTY! ABANDON HOUSE SEWER
AND STATE OF RNIA 0 HAT I AM T _ LEGAL OWN-
ER OF THE AB ESCRIBE ESI ENTIA PROPER Y. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E) CESSPOOLS
SIGNATURE � ( '
OF PERMITTEE-------- - - - _..__.....- -.._....
76A642D 663 1/53