HomeMy Public PortalAbout6222 KAUFFMAN AVE_Sewer__ DEPARTNENT OF COUNTY ENGIINEEEER, 'SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY ."I, : PERMIT APPLICATION
t COUNTY OF LOS ANGELES BUILDING . d /-N . •
�•,` WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS 6� /�
FOR APPLICANT TO FILL IN LOCALITY (l•,z�vlx
BUILDING NEAREST
ADDRESS CROSS ST. V
LOCALITY "� DISTRICT N0. SERIAL NO. PERMIT-NO. C
NEAREST S
�! A d 7
CROSS ST.
RECEIVED BY Ready for Inspeetlon,: DATE ISSUED
OWNER
MAIL / w4 USE ZONE &OCCUPANCY_ MAP } •,
ADDRESS / BK PO
'CITY ` TEL.NO. I �7
CONTRALTO CO.IMP.NO.
ADDRESS JOB.N0.
CITY TEL.NO. TRUNK PEhMIT/N0. a ��
REGISTRATION NO. 2 COUNTY
ROAD PERMIT N0. � � LLEGAL �
DESCRIPTION LOT NO. STATE ENCROACHMENT T '
PERMIT NO.
BLOCK TRACT INDUSTRIAL t
WASTE APPROVAL
SIZE OF LOT .r� �/ NO.OF BLD S.
NOW"ON LOT r- CHARGES
USE OF
BUILDINGS CONN ECTION4CHARG FEE `
'NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ' REIMBURSEMENT FEE
PUBLIC'SEWER @ S 3.80 j SD RECEIPT NO. `I D TE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPT ON RECOR ED >"
WORK TO HOUSE SEWER 1,00 �.
ALTER OR REPAIR EXISTING NO DATE BY
SEWER OR;DISPOSAL SYSTEM 1.00 a:
DISCONNECT-'ABANDON SEWER c
AND/OR.DISPOSAL SYSTEM I 1 1.00 CONNECTION DATA
SEPTICJANK,.SEEPAGE PIT OR ^
PITS AND/ORDRAINFIELD 2.00 STATION ,.9.�GU ,� - DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00I �_„[J MANHOLE REFERENCE "
CJS O .",.--- • :��.;
..UPPER b6dY.ER, �,-
TYPE 0FtlMHkECTIOH LENGTH FROM -,( �'
Y CURB P.K_ Ll M.L.TO P.L. L_6
OWNERS PERMIT 1 00 = ,
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH HE HEREIN' NAMED l�Y
CONTRACTOR TO CONNECT THE ABOV SCRIB D EXISTING APPROVALS t' INSPEcroR'ssICNATUR DATE
DWELLING TO THE BLIC SEWER
SIGNED THIS.-_-.�- __DA F _ ..___._ ._..___._.__..I _' NEW HOUSE SEWER C .+% As
•---
OWNER( "OR CONNECT ADDITIONAL r
OWNERS AGENT_..._. _ "---,_-.___ ' BUILDING OR WORK
........
SEPTIC TANK,SEEP.PIT(S)
ADDRESS... (:__. _--� �. A-/ AND/OR,DRAINFIELD
CAI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL 0 DRYWELL
TION 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,1 AM PROPERLY REGISTERED DISCONNECT-PLUG AND'
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCON NCTOPLU 'AN&- _'=
AND STATE OF CALIFORNIA 0 AT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIB SIDENTIAL PROPERTY. BACKFILL SEPTIC'TANKS I]
SEEP.PIT(S)[3 CESSP-OOL'S I]
SIGNATURE Y
OF PERMITTEE -
76A642D 663 1/53 ; '