HomeMy Public PortalAbout4910 ENCINITA AVE_Sewer__ DEPARTMENT OF COU74W ENGINEER SEWERSEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY 4F LOS ANGELES
WILLIAM J. FOX, COUNTY ENI3INEER ADDRESSIBUILDNG
FOR APPLICANT TO FILL IN LOCALITYBUILD
EI
NG NEAREST
ADDSS CROSS ST
LOCALITY DISTRICT NO SERIAL NO PERMIT NO
NEAREST A 2201- 7J
CROSS ST
RECEIVED BY Ready for Inspection DATE ISSUE
OWNER �J
MAIL
ADDRE - USE ZONE OCCUPANCY B�K/jMAP PG
CITY TEL NO 1,9-
CONTRACTOR'
CONTRACTOR � y0. �µy���y CO.IMP NO
ADDRESS `pv JOB.NO
CITY R TEL N6'*-r�Oc� TRUNK PERMIT NO
STATE
REGISTRATION NO ' COUNTY �+
ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO � � ` rOl76.4 STATE ENCROACHMENT
PERMIT NO
BLOCK TRACTl�0Gf. INDUSTRIALWASTAPPROVAL
I
SIZE OF LOTCNO OF BLDGS
USEOF
- )( �VC1� NOW ON LOT r CHARgES
BUILDINGS ��Q CONNECTION CHARGE FEE
s
NO DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 350 RECEIPT NO DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00 NO DATE BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 I CONNECTION DAT),
SEPTIC TANK,SEEPAGE PIT OR �-
PITS AND/OR DRAINFIELD 2.00 I STATION A=( 7—, 4J7-_7 DEPTH
SPECIAL CONDITIONS ONLY 200 I e MANHIll F REFERENCE
�S QUPPER) / /-- �-LOWER
TYPE OF-CONNECTION LENGTH FROM
OWNERS PERMIT I I <Y� a CURB% cP L- M L TOP L
AUTHORIZATION TOTAL FEE -.9z 1-5-0
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TOTHE PUBLIC SEWE
SIGNED THIS�S �" DAY OF NEW HOUSE SEWER jj_
OWNER OR / CONNECT ADDITIONAL
(�� ' BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP.PIT(S)
ADDRESS 7 L Ui AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ HIS APPLI- CESSPOOL[:] DRYWELL E]
GA NONAND 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
ANDS ATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAZPOPERTY BACKFILL SEPTIC TANKS
SEEP PIT(S)❑ CESSPOOLS s
SIGNATURE
OF PERMITTE
76A642D 663 1/53