HomeMy Public PortalAbout5010 ENCINITA AVE_Sewer__ ` ED
6&E-663 12.54 APPLICATIONPERMIT
ERMIT - 1
1'6 3 •6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE ®I S POSA i.
Department of County Engineer
County of Los Angeles BUILDING /v
WM. J. FOX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING •LOCALITY
gem
FOR APPLICANT TO FILL IN NEAREST+ Q� '
CROSS ST. O "j� _
LEGAL ` �2t
DESCRIPTION LOT NO. B-�r 5 � OWNER
BLOCK TRACT (G15j� • MAIL
ADDRESS
SIZE OF LOTA6I�/Ab NOWOON LOTS- / A
CITY l T L. NO..
USE OF
BUILDINGS JC�'3 �ss-� -DISTRICT NO. GROUP I MAP
yo I BK PG
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CONTRACTOR'S� �l Ji'
ADDRESS/7,0o
CONNECTION DATA
CITY' - TEL. NO STATIONQ ,�,,,,�� DEPTH
� 1 79 STATE r MANHOLE REFERENCE
REGISTRATION NO. �. ❑ COUNTY � OO, � J UPPER 9B1lGefi
TYPE O NEC7 N LENGTH FROM
NO. DESCRIPTION OF WORK FEE Y. URB' P L. M L TO P L ✓
THOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. / S JOB NO
_ WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING /��514
GQ
_ SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO. J
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO.
-SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
'SPECIAL CONDITIONS ONLY 2 00 CHARGES All
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00 ✓
AUTHORIZATION TOTAL,FEE REIMBURSEMENT FEE
TRACTORHAVE T TOS CONNECTDATE ONTRTHEA ABODVEWDESCR BEDITH THE HEREXISTINGAMED DWELLING APPROVALS -DATE IN PECTOR'S SIGNATURE
TO THE PUBLIC SEWER - NEW HOUSE SEWER
SIGNED THIS DAY OF 19-
OWNER OR -.` CONNECT ADDITIONAL -
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S) '
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1HAVE 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 PROPERLY REGISTERED AND/OR DISCONNECT PLUG,AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON DISCONNECT
-
CALIFORNIA OR THAT I AM THE LEGAL O R OF THE ABOVEHOUSE
DESCRIBED RESIDENTIALrEkOPERTY. 01 -BACKFILL SEPTIC TANKS❑
�j SEEP.PIT(S) ❑- CESSPOOLS
SIGNATURE 1� -
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
�^BY
MlY2 .6
,6 7 n � 7 A• 4.50
DEPUTY DEPUTY
BY _ - - e` BY
'® DEPUTY - DEPU