HomeMy Public PortalAbout6226 KAUFFMAN AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELESNG
+� /
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS
EOR APPLIC FI LOCALITY (
BUILDING NEAREST `-�
ADDRESS CROSS ST.
LOCALITY
DISTRICT N0. SERIAL N0. PERMIT NO.
NEAREST A /,570_g'0 3
CROSS ST.
GBEC IVED BY Ready for Inspection 9�`��IS8UED
OWNER
oojj // J 3
ADDRAl LESS / USE ZONE OCCUPANCY �BK MAP
v PG
CITY TEL.NO.
CONTRACT CO.IMP.NO.
ADDRESS JOB.NO. ..�-----
CITY ELAO. L/ 3 TRUNK PERMIT N0.
REGISTRATION NO. r1 TE
/:2 -9"i'4T COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT INDUSTRIAL �.
WASTE APPROVAL
SIZE OF LOTNO.OF BLDGS.
0 4�0 ) NOW ON LOT CHARGES
USE OF ' /
BUILDINGS CONNECTION CHARGE FEE _
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER I @ $ 3.50 --7)15-6 RECEIPT NO. I NVE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM I.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO.
ALTER OR REPAIR EXISTING I / DATE IBY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION-DATA
—SEPTIC TANK,SEEPAGE PIT OR — �+ O
PITS AND/ORDRAINFIELD 2.00 STATION � DEPTH - -
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 /6 � ER
MANHO REFERENCE MWIFR
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT`; $ I 00 -
Y. CURB `P'L'C M.L.TO P.L.
AUTHORIZATION TOTAL FEE. q yo
I HAVE THIS DATE CONTRACTED WITH THE HE EIN NAMED
CONTRACTOR TO CONNECT T ABOV ESCRI D EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TH/E UBL WER r
SIGNED THIS..-.A --.---. OF----- 19r_/ NEW HOUSE SEWER ��i�
a .
OWNER OR CONNECT ADDITIONAL
OWNERS ENT...-- BUILDING OR WORK
�t = SEPTIC TANK,SEEP.PIT(S)
ADDRESS It_ ..4-.-. .... ..... .. ..J-[.. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE HAT'I.H'AVE READ THIS PPLI- CESSPOOL[] DRYWELL
CATA
ION 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•1 AM THE LEGAL OWN-
ER OF THE ABOyf DESC RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I]
SEEP.PIT(S)[3 CESSPOOLS I]
SIGNATURE
OF PERMITTEE.----- - - - ----------------------------.......
i 76A642D 663 1/53