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Home My Public Portal About4857 ENCINITA AVE_Sewer__ `ELBA 4"2 76 A642L APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING _ / ADDRESS L a /�'� - t &I i f AV 'LOCALITY { ,(�' IZQ_.,e FOR APPLICANT TO FILL IN NEAREST S "C,� CROSS ST LEGAL , DESCRIPTION LOT NO (5...� -2. OWNER AIR g9�� l�, r C U /� -1 ADDRESS APRs- n �) e MAIL BLOCK TRACT J. _`� � (9 p qq NO OF BLDGS ! CITY -L STEL NO ® 7 T G SIZE OF LOT 7/5-0 NOW ON LOT USE OF BUILDINGS 9.00 19� CIAAI DISTRICT NO GROUP MAP PRO SSED BY A NO IlK �q PG CONTRACTOR 0&4-1 ��"''�'� ADDRESS CONNECTION D A CITY TEL NO STATION DEPTH STATE LIC MANHOLE REFERENCE UPPER LICENSE NO CLASS LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER PC No - SEPTIC FANK SEEPAGE PIT OR d PITS AND/OR DRAINFIELD Q CO IMP NO JOB NO O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO V FRI VATE DISPOSAL SYSTEM CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER E4110INT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ O OVERFLOW SEEPAGE PIT DRAINFIELD ~ EXTN CESSPOOL DRYWELL M HWY OR ST WIDENING W LT EPAIR OR ABANDO HOUSE OR DISPOSAL SYSTEM @ STATE ENCROACHMENT N PERMIT NO 3 9 3 INDUSTRIAL WASTE APPROVAL L OWNERCHARGES PERMIT s CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE _ IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNATURE , SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPO L ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LT EPAIR SEWER OR /fi^J LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF AGE DISPOSAL SYSTEM CA�IFp RN IA OR THAT I AM THE LEGAL OW ER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED R IDE TIAL PR PERTV ABANDON HOUSE SEWER SIGNATURE OF PERMITTEBACKFILL SEPTIC TANKS ElE ❑ SEEP PIT(S) ❑ CESSPOOLS DATION CK M 0 CASH 589EFEB 16 Q 9.00A DEPARTMENT OF COUNTY ENGINEER DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL 1 PERMIT APPLICATION COUNTY OF LOS ANGELESBUILDING WILLIAM J. FOX, COUNTY ENGINEER ADDRESS .CASSATT D GRIFFIN, SUPT OF BU LDIND FOR APPLICANT TO FILL IN LOCALITYb NEAREST s ADDRESS' CROSSSTAl LOCALITY DISTRICT NO SERIAL NO PERMIT NO c NEAREST A 3 7- c l/� S CROSS ST RECEIVED BY Ready for Inspection DATE ISSUED OWNER �, - •+' S� MAIL , ADDRESS USEZONE I OCCUPANCY \�MAP BK PG CITY TEL NO CONTRAC OR CHARGES s REIMBURSEMENT FEE ADDRESS �� REQUIRED �L. NOT REQUIR CITY L • TEL NO JOB NO-"' CONNECTION CHARGE FEESTATE S'�- REGISTRATION NO `-f4p- 113&113 C011666WAL CO IMP NO 17 J A fs� DELEGLSCRIPTION LOT NO / "`r/ � �(, �- RECEIPT HO I DATE I BY BLOCK S„•TRACT - �-� �6..1« WAIVER FOR RECORDING SIZE OF L0T�1J NO OF S NOW ON LOTRECEIPT N0,_ USE OF BUILDINGS NO DESCRIPT ON OF WORK FEE TRUNK PERMIT NO HOUSE SEWER CONNECTING TO F ROAD PERMITI PUBLICSEWER @ $ 350 ) �� HOUSE SEWER CONNECTING TO STATE ENCROACHMENT PRIVATE DISPOSAL SYSTEM 1 00 PERMIT NO CONNECT ADDITIONAL BLDG OR INDUSTRIAL WORK TO HOUSE SEWER 1 00 O WASTE APPROVAL _ ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1 00 CONNECTION DATA DISCONNECT AND ABANDON SEWER ^ 0 AND/OR DISPOSAL SYSTEM 1 00 STATION O D PTH SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2 004 MANHOLE REFERENCE 5 B CESSPOOL—DRYWELL I I UPPER SPECIAL CONDITIONS ONLY 200 TYPE OF CONNECTION LENGTH FROM / _Y� CURB f.CA -PrL M L TO P L OWNERS PERMIT $ 1 00 f AUTHORIZATION TOTAL FEE I I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED THIS .�1� AY F Cµ/J�` 19�•� NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENTl• r` nNCiL�. BUILDING OR WORK SEPTIC TANKSEEP ADDRESSh(6 b 7 '( AND/OR DRAINFIELD PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL ED DRYWELL❑ CA TICN AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND DISCONNECT PLUG AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGANDUSE f AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED jiESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS Q�' _ _ ` A � ',C // r' SEEP PIT(S) CESSPOOLS S SIGNATURE GGL °Q//// ti OF PERMITTEE 76_L6421) 664 12/ 2