HomeMy Public PortalAbout4938-4942 ENCINITA AVE_Sewer__ ERMIT
WER-SEWAGE DISPOSAL 1
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CAS AIT D. GRIFFIN, Sup't of uil y
FOR APPLICANT TO FILL
EGAL
RIPTION LOT NO.
K TRACT
NO.0' BLDGS. TEL. NO.
OF LOT NOW ON LOT DI NO. GROUP MAP 1'�ROCESS BY
DINGS ,
OF BK G
RACTOR , .• ,. , �'"' CONNECTION DATA
ESS
.,,.- -g,/eC•-6 $ _ y— J� .r S DEPTH
TEL.N0.. s. E REFERENCE _
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STRATTON NO. OWER
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DESCRIPTION OF 0 E`
HOUSE SEWER CONNECTING TO PE0 ION LENGTH FROM
PUBLIC SEWER @ $3.00 'P CURB I P.L. M.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00•
OVERFLOW SEEPAGE PIT, DRAINFIELD J - P.C.NO.
EXTN., CESSPOOL. DRYWELL @ $2.00 NO. /- / JOB NO.
HOUSE SEWER CONNECTING TO f
PRIVATE DISPOSAL SYSTEM @ $1.00 T RM IT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR $1.00
WER 5 - :+ S CROACHMENT
P
.I
1y
VAI
CHARGES
CHARGE FEE
ENT FEE
DATE A CONTRACT WITH THE NNECT THE ABOVE DESCRIBED EXISTIINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
SEWER.
SIGNED THIS DAY/'OF 19_ NEW HOUSE SEWER `S
OWNER ORCONNECT ADDITIONAL
AGENT
OWNERS AGENT �C BUILDING OR WORK
SEPTIC TANK,SEEP. PIT(S)
ADDRESS AI:D/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
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 ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWN 'OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDENTIAL PROTERTY. r SEEP.PITS) ElCESSPOOLS ❑
SIGNATURE
OF PERMITTEE
®� V LIDATION ROBERT A. WOOD
C14
M.0. CASH SUPERVISING MECHANICAL ENGINEER
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