HomeMy Public PortalAbout5024-5030 ENCINITA AVE_Sewer__ •y.76A642D APPLIs _ TIO ,FOY • PERMIT 7
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t DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer _ _
County of Los Angeles ppoRessU�?o.st�� r���/T/7- /i�c��
FOX. COUNTY ENGINEER
�CAS5ATT D. GRIFFIN, SUPT OF BUILDING LOCALITY - /•� � �
FOR,APPLICANT TO FILL IN NEAREST1
CROs sT. lG�LYJc2d l'/, i�,1/fJ
LEGAL ,
!DESCRIPTION LOT NO OWNER
BLOCK TRACT Z,%'OfiC MAIL
�17�✓•" i��1 ADDRESS 'G�`/!G//� F %I/✓C ✓
SIZE OF LOT ��� Z NOW ONBLOTS / CITY Il�G, TEL. NO.
USE OF 247
/'
BUILDINGS C. 24742Ze17,, / + 'DISTRICT NO. ] GROUP' MAP,BK PG
CONTRACTO�.'(�',�`� /I'• J!'!!'i�j 6;-
ADDRESS CONNECTIOPi DATA �-
CITY:' - ' 'TEL. NO. '�^'`"(' TATIOt I DEPTH c%- '
7ErSTATE l NHOLE REFERENCE
REGISTRATION NO 1y. c ' crt9^5.A•.-'--/
D COUNTY � /�/1• LOWER
TY F CONNECTION LENGTH FROM (`/d
No DESCRIPTION OF WORK FEE
-C+tlf+� v.�E.!„r M L.TO P L
HOUSE SEWER CONNECTING TO
PUBLIC SEWER �_Q $ 3.50 )
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG. OR -^"' CO�'IMP N0. /� 7 JOB NO.
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING
,SEWER OR DISPOSAL SYSTEM 7 00 TRUNK PERMIT N0. ROAD PERMIT NO.p� S
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/CR DISPOSAL SYSTEM 1 00 'PERMIT NO
•SEPTIC TANK, SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL \ �1�G VI'1 ✓
CESSPOOL- DRYWELL WASTE APPROVAL 'A^p- c, o. �-�
SPECIAL CONDITIONS ONLY 2 00 - CHARGES
_ CONNECTION CHARGE FEE
OVMER'S PERMIT S 1 00
AUTHORIZATION TOTAL-FEE REIMBURSEMENT FEE 11
I HAVE THIS DATE CONTRACTED'WITH T14E HEREIN NAMED CON- I
TRACTOR TO CONNECT THE ABOVE'DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER - , •-
NEW HOUSE SEWER �I
SIGNED THIS AY�OF -- - - 19- -
-OWNER --OR° CONNECT'ADDITIONAL 1
OWNERS AGENT � J �mJl./• BUILDING OR WORK y
ADDRESS - SEPTIC TANK, SEEP, PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[:1DRYWELL El '
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 -
IHEREBY CERTIFY THAT I AM PROPERLY"REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY'AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT •1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
�,�✓,�,y �/, /
'SEEP. PITS) ❑ CESSPOOLS❑
SIGNATURE / �/�1• G._1/`�'!�/tif�/����.�,�/,.� ,�.d� - I +
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER' VALIDATION
is o0'- tea 11 4 45
0 m
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DEPUTY * v DEPUTY 3Y
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