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HomeMy Public PortalAbout4924 ENCINITA AVE_Sewer__ \ TE)!cirt— 82 78AG42D APPLICATION FOR PERMIT 8A642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE, COUNTY ENGINEER ADDRESS 4924 Encinit TempleZ7 COLEMAN W JENKINS SUP T OF BUILDING J LOCALITY NEAREST FOR APPLICANT TO FML IN `ROBS ST LowevZ(il LEGAL DESCRIPTION LOT NO OWNER MAIL 22 W. Main St. BLOCK TRACT ADDRESS NO OF BLDGS Los Angel"L NO SIZE OF LOT NOW ON LOT CITY USE OF DISTRICT NO GROUP MAP PROCESSED BY BUILDINGS single family difirelli I tt T 7.^� B KM PLG CONTRACTOR V V• V / • — 0/ _< , ADDRESS 135 N. Daisy Ave. CONNECTION DATA/� CITY Pasadena NO STATION 7*0.9, /DEPTH Y' STAT LIC MANHOLE REFERENCE / UPPER LICENSE NO 13370-C21 GLASS �O/i ' s (' 4/"OR NO DESCRIPTION OF WORK FEE TYPE OF CTI ON LENGTH FROM HOUUSE SEWER CONNECTING TO Y P L ML TO P L d PBLIC SEWER @ $5 00 PC NO SEPTIC TANK SEEPAGE PIT ORJOB NO O PITS AND/OR DRAINFIELD @ S1000 CO IMP NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO w PRIVATE DISPOSAL SYSTEM @ $300 O CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 u OVERFLOW SEEPAGE PIT DRAINFIELD Lu EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 d ABANDON HOUSE HWY OR ST WIDENING h SEWER SYSTEM $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL /�1 WASTE APPROVAL �/ r��J CHARGES OWNERS PERMIT S 2 00 AUTHORIZATION i TOTAL FEE CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWS //ryry DATE INSPECTOR S SIGNATURE SIGNED THIS �/ DAY OWNER OR NEW HOUSE SEWER OWNERS AGENT _ CONNECT ADDITIONAL ADDRESS �}� J BUILDING OR WORK (/ SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HA READ THIS APPLIC ON AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO C PLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGU ING PLUMBING AND SEWERS CESSPOOL Cl DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED D/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY A GLES C UNTY AND T TE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I A H LE AL OW R NO END TO DISCONNECT PLUG AND /r RESIDE IN THE AB OV D IBE RESI T OPE ABANDON HOUSE SEWER SIGNATURE /7BACKFILL SEPTIC TANKS ❑ OF PERMITTEE Cf"� SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION JACK R ALLEN cK M o CASH SUPERVISING MECHANICAL ENGINEER � !'_ 0 9 3 4� JUL 14 1 0 D 5.0 0- , DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELESBUILDING p WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS LOCALITY FOR APPLICANT TO FILL IN— � T—►C BUILDINGNEAREST ADDRESS / � h'r A/ CROSS ST LOCALITY DISTRICT NO SERIAL NO PERMIT NO C A NEAREST A 145 CX04m CROSS ST � RECEIVED BY Reedy for Inspection DATE ISS ED OWNER MAIL / W cl�1— ' 3 ADDRESS [�/O `p USE ZONE I OCCUPANCY SK MAS PG CITY I� TEL.NO.G 7/0 o �' ( as CONTRACTOR &---e R�/��•,� CO.IMP NO. 1 — ADDRESS t�2g J/ ` JOB.NO. ® 1 CITY �.�— TEL NO.A—P&d/lOd TRUNK PERMIT NO. STATE REGISTRATION NO f yG�C/ ® COUNTY 2VI17� ROAD PERMIT NO LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO �� ��P �Y@,I" PERMIT NO -- BLOCK TRACT INDUSTRIAL i I NO OF BLDG8. ) WASTE APPROVAL SIZE OF LOTJG' Q(g NOW ON LOT I CHARGES USE —BUILDINGS CONNECTION-CHARGE FEE NO DESCRIPTION OF WORK FEE / HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE L PUBLICSEWER @ $ 350 TrCS RECEIPT NO TE BY HOUSEHOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1 00 CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1 00 NO ALTER OR REPAIR EXISTING DATE BY SEWER OR DISPOSAL SYSTEM 1 00 DISCONNECT AND ABANDON SEWER _ AHD/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 200 STATION r Q G DEPTH CESSP00 L—D RYW ELL SPECIAL CONDITIONS ONLY 200 C"1©I / �Q MA UPP E REFERENCE TYPE OF•CONAF CT10 LENGTH FROM OWNERS PERMIT ; I ( CURB 2 � AUTHORIZATION TOTAL FEE I �e 0—a 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 _�.�._DAY OF,lk —'& _19_�;) NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK J AA SEPTIC TANK,SEEP.PIT(S) ADDRESS {_�- - _. _ ^I^r;�r�'. _ AND/ORDRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL DRYWELL 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 f AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER x AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS ElI i SEEP PIT(S)E] CESSPOOLS© SIGNATURE OF PERMIT 76AG42A 663 7/53 _ 7�E H P L E c,�-Y :E808 5"65 CA642D APPLICATION FOR PERMIT 7 EA 64 - L.J COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE, County Engineer ADDRESS COLEMAN W JENKINS, Sup't of Building LOCALITY / NEAREST f! FOR APPLICANT TO FILL IN CRDSB ST LEGAL DESCRIPTION LOT NO Z OWNER MAIL BLOCK TRACT ADDRESS NO OF BIL GS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO I GROUP MAPPROCESSED BY BUILDINGS �'` BK PG CONTRACTOR -/l Og 1 M 65 ADDRESS CONNECTION DATA STATION _ ,F Q7E DEPTH A 7C CITY /� 1 TEL NO ! V :J LICENSE LICENSE / / UPPER CLASS C MANHOLE REFERENCE NO -,9e- /e7 s O NO RI TION OF WORK FEE TYPE OF CONNECTION LENG H FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER @ $ 5 00 SEPT SEEPAGE T OR CO IMP NO JOB NO CL PITS AND/OR DRAINFIELD C $10 00 O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO V PRIVATE DISPOSAL SYSTEM C $ 3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER I EASEMENT RECORD INSTR t DATE O WORK TO HOUSE SEWER @ $ 3 00 ABANDON HOUSE ~ SEWER OR DISPOSAL SYSTEM C $ 3 00 HWY OR ST WIDENING a EXTN CESSPOOL MANHOLE @ $ 5 00 STATE ENCROACHMENT /J PERCOLATION TEST @ $ 5 OG PERMIT NO aC a/�JYIIr INDUSTRIAL # 1906 WASTE APPROVAL \� OWNERS PERMIT $ i 00 CHARGES AUTHORIZATION I TOTAL FEE 5_- CONNECTION CHARGE 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 r BUILDING OR WORK ADDRESS SEPTIC TANK SEEP PIT(S) 1H ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 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 CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I ROPER REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED B O ANGL OUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I LEGA O ER OF INTEND DISCONNECT PLUG AND RESIDE IN THE AB IBED E ENTIA RTY ABANDON HOUSE SEWER SIGNATURE ` BACKFILL SEPTIC TANKS ❑ OF PERMITT SEEP PITS) ❑ CESSPOOLS ❑ VALIDATION CK M O CASH �' 1 0 0 5 17 1