HomeMy Public PortalAbout5039 ENCINITA AVE_Sewer__ f
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S&E-689 I f-98 APPLICATION FOR PERMIT 1
8 8 6.8 I "
` DIVISI&N dF`$UILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer ,
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® - CASSATT D. GRIFFIN, SUPT OF BUILDING .LOCALITY J
FOR APPLICANT TO FILL IN ceoss ST.
LEGAL OWNER
DESCRIPTION - {LOT NO.
MAIL
BLOCK - TRACT - ADDRESS
N0. OF BLDGS -
SIZE OF LOT - NOW ON LOT CITY TEL. N0.
USE OF
BUILDINGS DISTRICT N9. GROUP BK MAP
T� P
CONTRACTOR 0q �l•1J �` —
CONNECTION DATA
ADDRES9� DEPTH STATION, �j l
r •� 7
21
CITY/�' �� TEL. NO. �j
MANHOLE REFERENCE (�� VP PE
STATE I ♦ L
REGISTRATION NO. Q ❑ COUNTY
No, DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE 0 CTION LENGTH FROM
_
PUBLIC SEWER @ $ 3 50 Y•" CURB P L M.L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR _
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT, DRAINFIELD �J _ P. C. NO.
EXTN ,CESSPOOL',DRYWELL,MANHOLE @ $2 00 CO IMP NO. 1_9 / JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO. ROAD PERMIT NO._-.7
CONNECT ADDITIONAL BLDG OR J STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 J D.Q PERMIT NO
ALTER REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVAL -
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS - DATE INSP CTOR SSIGNATURE --• `
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER _ NEW-HOUSE'SEWER y
SIGNED THIS_ -DAY of CONNECT ADDITIONAL
OWNEROR BUILDING OR WORK
OWNERS AGENT . T
_ SEPTIC TANK,SEEP,PIS)
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
I HEREBY CERTIFY THAT I AM PRO RLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED LO ANG COUNT AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT M M OWNE OF THE ABOVE _
DESCRIBED RESIDENT RO E : SEEP BACKFILL
PIT(SEPTIC TANKSO CESSPOOLS
SIGNATURE
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATIO ROBERT A WOOD, CHIEF PLBG INSPECTOR
CK N 0. CASH
f03 6 0 O� FE$29 4 5.5 t'
-62
7CEBOB
6A642D APPLICATION FOR PERMIT
6A642tJ
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS TiYaDB
WILLIAM A. JENSEN, Sup't of Building LOCALITYNEAREST__FOR .APPLICAN -T_O- L-IN- `R°55 5T LEGAL
DESCRIPTION LOT NO OWNER 6j pJ�ja "MAIL
BLOCK TRACT ADDRESSJr
SIZE OF LOT NO OON LOTF D S CITY `� TEL LD
NO USE OF DISTRICT Z-0
P MAP
BUILDINGS
1 BK PG
CONTRACTOR /
ADDRESS ,Z�a ,y../ )NNE(
STATION
DATA
CITY C/yl 1! /fir TEL NO �,7 2 STATION DEPTH
STATE UPPER
REGISTRATION NO COUNTY MANHOLE REFERENCE LOWER
NO DESCRIPTION OF WORK FEE TYPE OF CONN N LENGTH FROM }
HOUSE SEWER CONNECTING TO Y P L M L TO P L 4
PUBLIC SEWER 55 O _ PC NO v
SEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO
PITS AND/OR DRAINFIELD @ SIO O
HOUSE SEWER CONNECTING TO T N B I OAD PERMIT NO O
PRIVATE DISPOSAL SYSTEM @ S300
CONNECT ADDITIONAL BLDG OR ' AFFIDAVI W VE E�SEM ENi R ORD INSTR NO DATE
WORK TO HOUSE SEWER @ $30 0
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL,DRYWELL,MANH OLE @ $500 \.
ABANDON HOUSE + HWY O ST WIDENING L•.
SEWER @ S300
STATE ENCR HMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
WR
CH 5
ONES PERMIT t i o0
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
ITHAVE AT THIS DATE A CONTRACT WIH THE HEREIN NAMED CON 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
- BUILDING OR WORK
ADDRESS SEPTIC TANKSEEP,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
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ .� f-
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR SEWER OR
LICENSEDAS REQUIRED BY LOS AN LES UNT AND STATE OF SEWAGE DISPOSAL SYSTEM ,, f/
CALIFORNIA OR THAT I AM 7 EG O R AND,INTEND TO DISCONNECT PLUG AND
RESIDE IN THE ABOVE DES BE RE I T RTY
ABANDON HOUSE SEWERL
SIGNATURE BACKFILL SEPTIC TANKS ❑ I s �� -' I
OF PERMITTEE [IElSEEP PIT(S) CESSPOOLS
VALM 0 ROBERT WOOD
CK M O
SUPERVISING MECHANICAL ENGINEER
CASH
Lti�,o 9 3 9 9 JAN 11 1 G D 5.0 0-
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