HomeMy Public PortalAbout4906 ENCINITA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEINER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES i
WILLIAM J. FOX, COUNTY ENGINEER I� or
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ADDRESS
ADDRESS
FOR APPLICANT TO FILL IN LOCALITYa
BUILDING NEAREST ll
ADDRESS 40 /4 r /�%�://V CROSS ST
LOCALITY DISTTaLr.T NO SERIAL NO PERMIT
NO
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NEAREST `A ' A �� • G� s
CROSS ST W B E' /; y ?�- CE ED BY. Revdy for Inspection DATE ISSUED
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OWNER 7J
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-ADDRESS / L�( M1 - /�%/y�/�LC/ USE ZONE OC�CUPANCY B MAP/PG
CITY TELAO.
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CONTRACTORCO.IMP NO
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ADDRESS �.3 o�t/ /go' JOB.NO
CITY /7`� �lj/ /��/ TEL NO. / - l�C���f TRUNK PERMIT NO.
REGISTRATION NO ❑ COUATE NTY
IV
(^ �/� ��j �// ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO /V�Q /d T`// `i-S' . 7h STATE ENCROACHMENT _
v PERMIT NO
BLOCKC /Z' TRACT A O / 7 - / -/ ,6 WASTE APPROVAL
SIZE OF LOT 8 NO OF BLDGS
NOW ON LOT � CHARGES �+
USE
BUILDINGS CONNECTION`C ARGE FEE
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NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 850 �(/ RECEIPT NO I „DA �I BY
HOUSE SEWER CONNECTING TO �J
PRIVATEDISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR /EXCEPTION RECORDED
WORK TO HOUSE SEWER 100 NO
ALTER OR REPAIR EXISTING 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
PITS AND/ORDRAINFIELD 200 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 M/4N11Oi-Fs�REFERENCE
tPURREBW LOWER
TYPE OF CONNE7Q LENGTH FROM
OWNERS PERMIT $ I Y CURB P L ML TO P L Q
AUTHORIZATION I TOTAL FEE
1 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
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SIGNED THIS .f d__DAY OF.._ 19 J NEW HOUSE SEWER
OWNER OR
CONNECT ADDITIONAL
/� BUILDING OR WORK
OWNERS AGENT �'� v' �
EPTIC TANKSEEP.
ADDRESS �v "' ' l�71/1�_//�i AND/OR DRAINFIELD IT(S)
I HEREBY ACKNOWLEDGE THAT I H READ THIS APPLI- CESSPOOL❑ DRYWELL s
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGALxOWN•
ER OF THE ABOVE DESCRIBED RESIDENTIAL PR PERTY BACKFILL SEPTICTANKB�
SIGNATURE SEEP PIT(S) CESSPOOLS
�OF PERMITTEE
76A642A 663 7/53 -