HomeMy Public PortalAbout6230 KAUFFMAN AVE_Sewer__ DEPARTAfENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES p�
\` WILLIAM J. FOX, COUNTY ENDINEERBUILD
I HADD EISS
R APPLICAKIT FIL LOCALITY.
BUILDING -NEAREST Q_
ADDRESS CROSS ST.
LOCALITY DISTRICT NO. V SERIAL NO. PERMIT NO.
NEAREST A
CROSS ST.
RECEIVED BY Ready for Inspection q DATE135UED-
OWNER
MAIL / USE ZONE OCCUPANCY MAP-
-ADDRESS ADDRESS /BIC PG .
CITY :TEL.NO.
—�`''
CONTRACTOR' CO.IMP.NO.
ADDRESS JOB:NO'
CITY EL.NO. TRU74K PE',
ATE
REGISTRATION.NO. 7 COUNTY ROAD PERMIT N.D.
LEGAL STATE ENCROACHMENT a
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 'l N0.OF BLDGS.
��[ /LL(/ NOW ON LOT CHARGES
USE OF'
BUILDINGS CONNECTION CHARGE FEE
-
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 +
CONNECT ADDITIONAL BLDG.OR EXCEPTIOf RECORDED
WORK TO HOUSE SEWER 1.00 1
ALTER OR REPAIR EXISTING NO.
SEWER OR DISPOSAL SYSTEM 1.00 I DATE\ I BY'
DISCONNECT AND ABANDON SEWER _
AND/OR DISPOSAL SYSTEM 1.00 CO NECTION DATA
SEPTIC TANK,SEEPAGE PIT OR _
_ PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 ¢g MANHOLE REFERENCE
O 11�8R LOW E
TYPE OFONNECTION LENGTH FROM
%cAm � M.L.TO P.L.
OWNERS PERMIT ; 1 00 .� d ! /
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONT,RACTED.WITH E HEREIN NAMED ..
CONTRACTOR TO CON ECT-THE ABOV D SCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE ..DATE
DWELLING TO THE ELIC SEWER
SIGNED THIS
_../.- ___-_.D I NEW NOU$E SEWER
= - - -
OWNER OR
CONNECT ADDITIONAL M
OWNERS AGENT._..._... BUILDING OR WORK
ti - - -
SEPTIC TANK,SEEP.PIT(S)
ADDRES . .e-__. .. ........ . . .. ...... ..... AND/OR DRAINFIELD
I HERAY ACKNOWLEDGE THAT I HAVE READ TRIS 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.-i-. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AMjPROPERLY' REGISTERED DISCONNECT PLUG AND
AND/OR LICENSEDrAS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE S EWER
AND STATE OF CALIF RNIA OR T I AM THE LEGALOWN-
ER OF THE ABOVE S RISE E IDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E] CESSPOOLS E]
SIGNATUREw�'•u'' ;_
OFPERMITTEE.--' --------- ...--=•---- ------- ......---...................--•-...
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