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Home My Public Portal About5008 ENCINITA AVE_Sewer__ 0-63 76A642D APPLICATION FO PERMIT 6A642ll COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING , JOHN A LAMBIE. County Engineer ADDRESS w" WILLIAM A JENSEN Sup t of Building LOCAL TY NEAREST FOR APPLICANT TO FILL IN CRDBS ST LEGAL I , DESCRIPTION LOT NO OWNER / MAIL BLOCK TRACT ADDR 5 1`10 OF BLDGS SIZE OF LOT NOW ON LOT CIT 1,1 tit, TEL NO USE OF FDRGROUP MAP PROCESSED BY BUILDINGS BK PGCONTRACTOR )ADDRESS CONNECTIODATA1 S' DEPTH CITY TEL NO4TATE REGISTRATION NO -LJ COUNTFERENCENO DESCRIPTION WO K FEE CONNECTION _LENGTH FROM HOUSE SEWER CONNECTING TO URB P L ML TOPLPUBLIC SEWER S5 00 i p C NO SEPTIC TANK SEEPAGE PIT OR JOB NO O PITS AND/OR DRAINFIELD SIO00 (� HOUSESEWER CONNECTING TO IT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $3 00 w CONNECT ADDITIONAL BLDG OR AFFIDAVIT wAlveq EASLMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ S3 00 �� ~ U OVERFLOW SEEPAGE PIT DRAINFIELD {J,t EXTN CESSPOOL DRYWELL MANHOLE @ SS OO H ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT Z PERMIT NO _ INDUSTRIAL �^ WASTE APPROVAL , 0�7 C epi OWNER'S PERMIT $ 2 00 CHARGES 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 DATE INSPECTOR S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER A ^. p OWNERS AGENT CONNECT ADDITIONAL "a` UL".�--.r &.Q R WORK �� !`{i�� ' •. ADDRESS SEPTIC TANK SEEP PIT(S) IH ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL 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 AN LES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR TH I AM THE LE OW OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE A O E DESCRIBED E AL PROPERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS ❑ ALIDATION ROBERT A WOOD SUPERVISING MECHANICAL ENGINEER CK M O CASH �� 5 0 3 21 OCT2 0 1 0 D 5,00 " c. f0-63 76A642D APPLICATION FOR PERMIT 6A64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING - JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY JA o4m/ NEAREST FOR APPLICANT TO FILL IN CROSS S LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT GJ ADDR S NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO 'USE OF DISTRICT N GROUPMAP PROCESSED BY BUILDINGS BK PG 1 CONTRACTOR ADDRESS `) CONNECTION DATA Q DEPTH CITY TEL NO x.. STATION •STATE UPPER Z MANHOLE REFERENCE REGISTRATION NO NO DESCRIPTIO O O FEE TYPE O C NECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y B P M L TO P L } PUBLIC SEWER $5 00 &7 PC NO 0. SEPTIC TANK,SEEPAGE PIT OR CO IMP NO JOB NO PITS AND/OR DRAINFIELD @Oslo 00 V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO —.. PRIVATE DISPOSAL SYSTEM @ 33 00 +, CONNECT ADDITIONAL BLDG OR 1 AFFIDAVIT I WAIVER EASEMENT RECORD INSTR ANO DATE O WORK TO HOUSE SEWER @ S300 FT OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN,CESSPOOL DRYWELL MANHOLE @ ES 00 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING N SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL tL -� - - WASTE APPR V OWNERS PERMIT s 2j 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVAL'S DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER l OWNERS AGENT CONNECT ADDITIONAL A I 7�Hy BUILDING OR WORK, ADDRESS -+ - SEPTIC TANK SEEP PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR,SEWER OR LICENSEDAS REQUIRED BY LOS ANG ES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEG OWN O AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB DESCRIBED SID TI AND ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE- ❑ SEEP,PIT(S) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD M O CASH SUPERVISING MECHANICAL ENGINEER LACa 5 4 5 '0�—Q NOV 2 1 0 D 5.00— cv