HomeMy Public PortalAbout4943 ENCINITA AVE_Sewer__ o
S&E68APPLICATION FOR PERMIT 1
8 e E DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING d
JOHN A LAMBIE COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY
FOR AP LI NT O FILL IN OWNER CROSS s
LEGAL ��+/yam/ ♦
DESCRIPTION L'OP NO v
MAIL
BLOCK TRACT- �'► ADDRESS
NO OF BLDGS CITY TEL NO
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT NO GROUP MAP
BK PG
CONTRACTOR
CONNECTION DATA
ADDRESS
STATION DEPTH
CITY TEL NO
MANHOLE REFERENCE
❑ STATE J LOWER
REGISTRATION NO ❑ COUNTY
NO DESCRIPTrOn OF WORK FEE
HOUSE SEWER CONNECTING TO _ TYPE 0 ION LENGTH FROM 9
PUBLIC SEWER @ $3 50 Y CURB P L M L TOP L � d
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN ,CESSPOOL,DRYWELL,MANHOLE Q $2 00 CO IMP NO 7 -377 JOB NO
HOUSE SEWER CONNECTING TO ,'3 O /7IO�
PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1 00 QQ PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S pERMT a 1 11,00
AUTHORIZATION I TOTAL FEE lI REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SE R NEW HOUSE SEWER 1J�
SIGNED THIS DAY OF 1 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGE le
zSEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE 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 PR ER LY REGISTERED A D/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LO AN ES COUN Y NO ST E OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM E OWN TH ABOVE
DESCRIBED RESIDENT O BACKFILL SEPTIC TANKS❑ 21,
SIGNATURE SEEP PIT(S) ❑ CESSPOOLS
OF PERMITTEE
JOHN A LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CK M 0 CASH
i
X03 774 AUG-121 A 5.5_ 0