HomeMy Public PortalAbout4900-4902-4904 ENCINITA AVE_Sewer__ Y
. 76A642D � e
X76 E 20 54 APPL' v ATI®N ,FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D1SPOSAL
Department of County Engineer 'D [
County of Los Angeles BUILDING A/f as•®2.
WM J FOX, COUNTY ENGINEER ADDRESS l....ff��.�
CASSATT D GRIFFIN, SUPT OF BUILDINWMMMG LOCALITY ��9�In/�
FOR APPLICANT TO FILL pI , NEAREST �•
LEGAL �d o F Y OWNER �'1 Ad NAS
DESCRIPTION LOT NO & 7(�P OWNER
BLOCK TRACT MAIL
32 SIZE_ OF LOT Q ; NOW NO OON LOTS ADDRESS �� TEL NO
USE OF
BUILDINGS AQs DISTRICT NO GROUP MAP
SK PGS
CONTRACTOR F/6 z
ADDRESS -k .4 do „rp .4 V e. CONNECTION DATA
CITY r TEL NO STATION 7 49 DEPTH a .
SaCOUN ANHOLE REFER F,AICE ! 1
REGISTRATION NO ❑ COUNTY - UPPER -/�� LOWER
TYPt FITC ECTION LENGTH FROM
No DESCRIPTION OF WORK FEE Y [ C� P L M L To P L �O
HOUSE SEWER CONNECTING f0 d�'
PUBLIC SEWER @ $ 3 50 GJ
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR rr�� �} A CO IMP NO 37 -7�7 JOB NO
WORK TO HOUSE SEWER 1 00 p( (d F.f ✓
ALTER OR REPAIR EXISTING +J
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT N%, ROAD PERMIT NO sC Q
DISCONNECT AND ABANDON SEWER STATE EN CROACHM T
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK, SEEPAGE PIT OR
OITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 C GES
• PEI4Ie2IT CONNECTION CHARGE F
OWNER'S ��
AUTHORIZATION TOTAL FEE REIMBURSEME FEE
TRACTORT
TTOI HAVE HIS CONNECTO THEA ABODEWDESCR BEDH EXISTINGA DWELLING APPROVALS DATE IN PECTOR SSIGNATURE
TO THE PUBLIC SEWER 1
SIGNED THIS JQ DAY OF - 194rNEW HOUSE SEWER
OWNER OR K� CONNECT ADDITIONAL - v
OWNERS AGENT FFFii4�� d a�'.� BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY CKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER- -
DESCRIBED RCSIDENIIAL PROPERTY BACKFILL SEPTIC TANKS❑
SEEP PIT(S) ❑ CESSPOOLS
SIGNATURE �nE5
OF PERMITTEE
Ari
i
WILLIAM J. FOX. COUNTY ENGINEER VALIDATION �p q
BY - �Q`�'Q A'tr,+'!`rz; $ tD
DEPUTY - _ l _ - __ y V DEPUTY
BY BY
® DEPUTY DEPUTY i"