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HomeMy Public PortalAbout5021 ENCINITA AVE_Sewer__ 76A6420 A MPPLICATION FOR PERMIT S&E-663 11.55 1 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING ��%� .T �[ JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS � /� T) CASSATT D. GRIFFIN, SUP'TOF BUILDING LOCALITY 7'k-//1 pg„ IF- NEAREST �'� FOR APPLICANT TO FILL IN CROSS ST. L GA Lv ' y Cr- U /®.S- ©T ,Ssc; OWNER DESC LOT N0. i 7 a � ,b is iw/ TRACT MAIL _ _ � ADDRESS ()�( � /�( - 7�) N0. O DGS. CITY •� /`� `y�C,�TEL. NO.Na 3 ✓` �" - SIZE OF LOT NOW ON LOT _ USE OF Pi IONS;„ �q w .DISTRICT NO. GROUP MAP BUILDINGS (/ � I BK PG CONTRACTOR �`t L1 f`� �-+�' 0,w rIv p,e •ry ../H ADDRESS ��'i /J��f� �' r - . CONNy/ECTION DATA CITY (,� �� NO. STATION /,zf<,e-Z-5-- DEPTH/ /0 �,p '� © STATE MANHOLE REFERENCE. LO REGISTRATION NO. ! 7� �y 2 �' ❑ COUNTY WER NO. DESCRIP-rIION OF WORK FEE 61`SF/`9 W7-- 6A %O OJ- HOUSE _HOUSE SEWER CONNECTING TO - TYPE OF CONNECTION LENGTH FROM wry PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L. V SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD P. C. N0, - EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $ 2.00 CO. IMP. NO, JOB N0.HOUSE SEWER ` PRIVATE DICONNECTING TO DISPOSAL SYSTEM @ $1:00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNERS PERMIT $ 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS' DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ? TO THE PUBLIC SEWER. NEW HOUSE SEWER S� S/j SIGNED THIS DAY OF 19 CONNECT ADDITIONAL r OWNER OR BUILDING OR WORK OWNERS AGENT 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 1ICHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LENSED AS REQUIRED BY LO 5 ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE _ DESCRIBED RES! NT AL ROp�RTY. BACKFILL SEPTIC TANKS❑ SIGNATURE . �6 SEEP. PIT(S) ❑ CESSPOOLS[:3 OF PERMITT E " ;e r JOHN A. LAMBIE, COUN ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR CK. M,O. CAS - I C�5 APR 16 4.5 0 �, N�, APPLICATION � ®® pry'° �y ® PERMIT ��/ � .� 76A66 2D -62 APPLI CA 1 ION FOR PERM I 1 V'� � COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER—St1/�/-A-G E D 1 S POSAL BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. County Engineer ADDRESS �y ,�/✓(P! j7 WILLIAM A. JENSEN. Sup't of Building LOCALITY jj9 G fi NEAREST FOR APPLICANT TO FIL IN CRDSS ST. LEGAL ///��� DESCRIPTION LOT NO. o �® OWNER `N�?�i��/S//T ��` ASeNG O AIL A BLOCK TRACT W ADDRESS D 'g�/�::> _-z s N6. OF BLDGS. SIZE OF LOT NOW ON LOT Q CITY <' i�7 TEL. NO. J �j ✓ —'C. USE OF DISTRIC NO. GROUP MAP OESSED BY BUILDINGS PG CONTRACTOR [CiDTY" RESS CONNECTION DATA ELNO. % �O /G SSTATION42 DEPTH ❑ COUNTY STATE MANHOLE REFERENCE ' �STRATION NO. • � LOWER DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM ❑3v$n HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 p,C.NO. SEPTIC TANK,SEEPAGE PIT OR CO.IMP. NO. JOB NO. PITS AND/OR DRAINFIELD @ $10.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER rASEMEMi RECORD. INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXT N.,CESSPOOL,DRYWELL,MAN HOLE @ $5.00 AyABANDON HOUSE HWY.OR ST.WIDENING .`_ SEWER Oa" S Q.9&.' "M @ $3.00 �Y STATE ENCROACHMENT s' PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT s 2 00 CHARGES AUTHORIZATION TOTAL FEE I CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONN. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1HEREBY CERTIFY THAT I AM P OPERLY RE E AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REoUIRED BY LOS GLES COU Y AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE EGAL NER , A NTEND*0 DISCONNECT PLUG AND RESIDE IN, THE ABOVE D E�D EN P ABANDON HOUSE SEWER L r f �•: SIGNATURE BACKFILL SEPTIC TANKS ❑ V OF PERMITTEE SEEP.PIT(S) ❑ CESSPOOLS ❑ ALI.0. ROBERT A. WOOD CK. M.O. SUPERVISING MECHANICAL ENGINEER CASH f'' 7 6 2 7- JAN 1 0 0 5.00- 7