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Home My Public Portal About5000 ENCINITA AVE_Sewer__ 3-64 76A643-64 APPLICATION FOR PERMIT 6A64 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUMDING AND SAFETY DIVISION BUILDING OO JOHN A LAMBIE, Count En ADDRESS Ares ry County g�neer WILLIAM A JENSEN, Sup t of Building L OCAL�TY NEAREST FOR APPLICANT TO L IN CROSS ST AL DESCRIPTION LOT NO45 / � ` OWNER y V MAIL BLOCK TRACT ADDRESS Q •t_ ,4, NOaSIZE OF LOT NOWOON LOGS I CIT TEL NO !3 + USE OF t ICT NO GROUP MAP PROCESSED BY BUILDINGS J BK PG CONTRACTOR ,T,+ � .166 ��7 A RESS r ` CONNECTION DATA ION DEPTH CIT TEL NO �J s� SOLE REFERENCE ` REGIS A ON NO C /V/ LOWER NO ESCRIPTION OF WORK FEE YPE OFC TION LENGTH FROM I-MUSE SEWER CONNECTING TO CURB P L M L TOP L Ar PUBLIC SEWER ® EB 00 SEPTIC TANK SEEPAGE PIT OR PC NO PITS AND/OR DRAINFIELD $1000 P NO 1-3-7-7 JOB NO d HOU 8E SEWER CONNECTING TO K PERMIT NO ROAD PERMIT NO O PRIVATE DISPOSAL SYSTEM ® $300 CONNECT ADDITIONAL BLOO OR AVIT wAlv[[ [A[[M[NT RECORD INBTR NO DATE O WORK TO HOUSE SEWER ® $300 OVERFLOW SEEPAGE PIT DRAINFIELD E%TN CESSPOOL DRYWELL MANHOLE ;800ALTER R PAIR OR ABANDON OUSE OR BT WIDENING dSEWER OR DISPOSAL SYSTEM E3 00 E ENCROACHMENT (nIT NO INDUSTRIAL /�, WASTE APPROVAL e" CHARGES OWNERS PERMIT s 2 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE PER _ I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE HAVE TO CONNECT TH ABOVE DESCRIBED ExI8TIN0 DWBLLING APPROVALS TO THE PUBLIC SEWS DATE INSPECTOR B SIGNATURE SIGNED THIS DAY F Q19 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK BEEP PIT(8) I HEREBY ACKNOWLEDGE THAT I 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 Cl I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND�OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL WNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABO E DESCRIBED DENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATIC� ROBERT A WOOD CK M o ( CASH SUPERVISING MECHANICAL ENGINEER E +-,'.�o 4 2 4 31 AUG 19 1 0 D 5.0 0 5 Sese 3353 APPLICATIOM FOR PERMIT ' DIVISION OF BUILDING AND SAFETY .!EWER—SEWAGE DISPOSAL Deportment of County Engineer MOMINXIIII=am �yq County Of LOS Angeles BULD'pDDRESSG��L� WM.J. FOX, COUNTY ENGINEER CASSATT D GRIFFIN, SUP'T OF BUILDING LOCALITY FOR APPLICANT TO pFILL IN CROSS STp 7_e �c;-I LEGAL t p�/ _ r /EI! y- r S DESCRIPTION LOT NO `6 /U e r J _x i / OWNER S��yyyy BLOCK TRACT j�y MAIL I ADDRESS se, ��// '! /' i� NO OF BLDGS SIZE OF LOTL� Y 1 & NOW ON LOT r CIT - TEL NO USE OF BUILDINGS (moi DISTRICT NO GROUP BK MAP PG CONTRACTOR G. r Sevv e r Constr. � I �' 1 /� �2 4, ADDRESS 4 508 �N 0 e En c I.n i to CONNECTION DATA �� f DEPTH CITY TEL NO STATION � � At 6 S A E MANHOLE REFERENCE .i'I ,^ �R REGISTRATION NO 152871 [1COUNTY - 7 ' LOWER NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TT TYPE O NECTI ON LENGTH FROM PUBLIC SEWER Q $ 3 50 V -Y CURB P L M L TO P L HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 100 _ CONNECT ADDITIONAL BLDG OR ' A ` �� JOB NO WORK TO HOUSE SEWER 1 00 V CO IMP NO d PAIR EXISTING SEWER OR ALTER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO SEPTIC TAN'<, SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL N CESSPOOL- DRYWELL WASTE APPROVAL st.E-L (�'� •.•Is SPECIAL CONDITIONS ONLY 2 00 CHA GES OWNER'S PERMIT 00 +' CONNECTION CHARGE FEE � > s AUTHORIZATION TOTAL FEE r/A REIMBURSEMENT FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCR ED EXISTING DWELLING APPROVALS DATE INS ECTOR S SIGNATURE TO ThE PUBLIC SEWER NEW HOUSE SEWER SIGNED THI AY OF 19 I wlyd.t ..w•• ... OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK SEPTIC 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 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR LICENSED AS REQUIRED B LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT 1 M THE LEGAL OWN OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTI PROPERTY BACKFILL SEPTIC TANKS C SEEP PITS) ❑ CESSPOOLS SIGNATURE OF PERMITIOJN uu� WILLIAM J. FOX,COLIN ENGINEER VALIDATION R A WOOD, CHIEF PLBG INSPECTOR _AG0 8 4 7 7 L SEP 29 4_ 6.5 0 �l