HomeMy Public PortalAbout4836 ENCINITA AVE_Sewer__ DEPARTMENT OF COUNTY ENGlNEES SEINER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING'AND SAFETY ;' PERMIT APPLICATION
COUNTY OF LOS ANGELES '
ADDRESS 3 �� /�/� IAII y
WILLIAM J. FOX, COUNTY ENOINEeR C
FOR APIc FILL IN
LOCALITY T
G.
BUILDI NEAREST
7ADDRESS CROSS ST y S /
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LOCALITY / DISTRICT NO. I Ready for Inspection PERMIT NCO
NEAREST
CROSS ST
RECEIVED BY DATE ISSUED BY DATE
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OWNER ��"���' /• IG4y�e%�G��7
MAIL
ADDRESS USE ZONE OCCUPANCY BK MAP PO
CITY
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CONTRACTOR CO.IMP NO. 3
ADDRESS JOB NO
CIT TEL N0. TRUNK PERMIT NOCe �—
STATE -
REGISTRATI N NO3 d OUNTY ROAD PERMIT NO
LEGL
DESCRIPTION LOT NO LS(�� o .OT�C7 I STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT 2 { INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTNO OF BLDGS
���"OO D NOW ON LOT J CHARGES
USE OF
BUILDINGS CONNECTION CH FEE
NO DESCRIPTION OF WORK FEE i
HOUSE SEWER CONNECTING TO ` REIMBURSEMENT FEE
l PUBLIC SEWER 0 $ 3 50 RECEIPT NO DATE BY
J— HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR - EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIEXISTING NO I 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 / G
PITS AND/OR DRAINFIELD 200 STATION / � DEPTH
CESSPOOL—D RYW ELL /r j
SPECIAL CONDITIONS ONLY 200 +�I /v ANHOLE REFERENCE LOWER
TYPE OF CONNEC�TI�O LENGTH FROM
Y �7
OWNERS PERMIT $ I 00 Y CURB r L M L TOPL L J
AUTHORIZATION TOTAL FEE -Y-.fL 16 --
1 HAVE THIS DATE CONTRACTED WITH THE HER IN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPEC OR'SSIGNATURE DATE
DWELLING TOTHE PUBLIC SEWER ..( j�
SIGNED THIS -DAY OF_._._ i�/�i NEW HOUSE SEWER
OWNER OR r IfLDING OR WORK
NECT ADDITIONAL
OWNERS AGE NTBU
( .�.��
_._ ____.__.__._.__�_� _____ _�._._._ SEPTIC TANK.NEEP.PIT(S)
ADDRESS
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT'I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL I]
CA
TIONAND STATE THAT THE A,SOVE 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 DISCONNECT PLUG AND f
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RE NTIAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE SEEP PIT(S)[] CESSPOOLS
OF PERMITTEE _.
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