HomeMy Public PortalAbout6229 KAUFFMAN AVE_Sewer__ DEPARTMENT OF COUNTY EPTGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING �
WILLIAM J. FOX, COUNTY ENGINEERI ADDRESS Co a?¢2 uG ?�•L.R -A
FOR APPLICANT TO ,FILL IN LOCALITY �
BUILDING NEAREST
ADDRESS v CROSS ST.
LOCALITY s DISTRICT NO. SERIAL NO. a PERMIT NO. c
NEAREST �; �» n r J
CROSS ST. ' ' ^ 3!1 ---
,y� RECEIVED 8 Ready for Inspection DATE ISSUED
OWNERS / ��•,�. `� `�`�
MAIL ` d
ADDRESS USE ZONE OCCUPANCY BKPG
���-- jp u TELNA.
CITY
1, -74
9 �y
CONTRACTOR i s� _.-�f�,J CO.IMP.NO. �j -.ems Ga.
ADDRESS Q �J �/yL t t�• JOB.NO.
CITY-
-�c t -- a TEL.NO+.� TRUNK PERMIT NO.
STATE
REGISTRATION NO. Iii /%`r ® COUNTY ROAD PERMIT NO. p2 SO
LEGAL J - STATE ENCROACHMENT
DESCRIPTION LOT N0. s PERMIT NO.
BLOCK TRACT INDUSTRIAL
wVASTEAPPROVAL �
F B
SIZE OF LOT oo�� // N0.OLDQB. 2 CHARGES
—
NOW
X I7Co• NOW ON LOT �.
USE OFCONNECTION CHARD . E�
BUILDINGS r
_Pl � � r ri�G
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE`t
HOUSE SEWER CONNECTING TO
PUBLICSEWER est $ 3.50 7'`o RECEIPT NO I DATE BY
HOUSE SEWER CONNECTING TO ;
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR n EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 d O
ALTER OR REPAIR EXISTING NO. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH �--
CESSPOOL—DRYWELL
SPECIALCONDITIONS ONLY 2.00 Q MANHOLE REFERENCE
no+.7R=� LOWER
TYPE OF CONNECTION LENGTH FROM
_X----- CURB —.Qnt. M.L.TO P.L.
OWNERS PERMIT ; I 00
AUTHORIZATION I TOTAL FEE s' —
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THF UBLIC SEWER S_ _
SIGNED THIS__,,-� DAY OF +-� .19.! NEW HOUSE SEWER (I 41 I` `�
CONNECT ADDITIONALOWNER 0
OWNERS AGENT_ .-_�_.___.._._!.�*_F�? .1..._ BUILDING OR WORK
» .__._ »x » __
//''" SEPTIC TANK,SEEP.PIT(S)
ADDRESS___________________...__._____.._..._..____...__._-_._._._...._1___�..__._____._...__ AND/OR DRAINFIELD
v
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL(] DRYWELL
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 DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE CRIBED RESIDEJ%TIAL PROPERTY. BACKFILL SEPTIC TANKS(�
SIGNATURE SEEP.PIT(S)� CESSPOOLSU"� '
OF PERMITTEE_ / �_._ -_ -_-_- _-. __.__.._ � t
76A642A 663 7/532�r
D
CE808.s-ss APPLICATION FOR PERMIT
_
eeos• COUNTY OF LOS ANGELES 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILD7sT �
ADDRE
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Sup't of Building LOCAL
NEARE
FOR APPLICANT TO FILL IN CROSS ST.LEAL
r
DESCRIPTION LOT NO. lvb L�a t OWNER `
BLOCK 16 TRACT �6G"ADDRESS /~
_ NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITYTEL.NO.
USE OF
BUILDINGS IDISTRICT NO. GROUP MAP PROCESSED BY
BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
,I CITY ® TEL. NO. STATION DEPTH
r' STATEMANHOLE R EB CE UPPER
REGISTRATION N0. �6� • COUNTY
NO. DEE 10 OF WORK FEE LOWER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTIO LENGTH P.
M
PITS AND/OR DRAINFIELD @ .$3.00 Y. CURB 11.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. R ERM IT N0.
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE! STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 1 PERMIT N0.
INDUSTRIA
WAST ROVAL
CHARGES
OVMER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 2 P0 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
:. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
i SIGNED THIS DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I 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 AT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS RE",,6_ BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR I AM E AL OWNER OF THE ABOVE
DESCRIBED RESTL PRO T BACKFILL SEPTIC TANKS❑
SIGNATURE
SEEP. PITS) ❑ CESSPOOLS El
OF PERMITTE
OF WALIDATION ROBERT A.WOOD
CK. M.o. CASH SUPERVISING MECHANICAL ENGINEER
SIO 3 3 '� -EP 30 3.00