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Home My Public Portal About5218 ENCINITA AVE_Sewer__ 7BA642D APPLICATION FOR PERMIT csaoa 11-57APPLICATION OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER ��—��E ®ASP®��L� BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS CASSATT D. GRIFFIN, Supt of Building LOCALITY FOR APPLICANT TO FILL IN NEAREST LEGAL DESCRIPTION LOT NO� ` TOWNER 2t94�1 BLOCKca) TRACTMAIL ./- ADDRESS NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL.N0. USE OF - - - BUILDINGS /�E� /�F'.''J�fLt'-� DISTRICT NO. GROUP MAP CONTRACTOR -. � � �. A I I B PG s - ADDRESSy,y/2'�" �, f� - CONNECTION DATA CITY`S �� TEL.N0. f.r y� ATION Q 17DEPTH REGISTRATION N0. ,�y, `f: � ATE ANHOLE REFER CE ER COUNTY NO. DESCRIPTION OF WORK FEE -—e--� _HOUSE SEWER CONNECTING TO PUBLIC SEWER @ TYPE OF CONNECTION LE H FROM �q SEPTIC TANK,SEEPAGE OR - Y. CURB P.L. M.L.TO P.L. � PITS AND/OR DRAINFIELDD @ $3.00 � OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00 / HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP.NO. CONNECT ADDITIONAL BLDG.OR �� WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0. ALTER,REPAIR OR ABANDON HOUSE y SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT $ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE TRACTOR TO CIONNECT THE ABOVE DESCRIBED EDATE A CONTRACT WITH THE XISTINGEINAMED DWEL ING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS C;7_6 19_ NEW HOUSE SEWER _ OWNER OR - `�� CONNECT ADDITIONAL - OWNERS AGENT ��°°�� BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) ADDRESS - AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION . AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR 1. HEREBY CERTIFY THAT I AM PROPERLY REGISTERED-AND/OR SEWAGE DISPOSAL SYSTEM -- LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I .hl THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTI PROPERTY. ; BACKFILL SEPTIC TANKS ❑ SIGNATURE S EP. PIT(S) [_1CESSPO S ❑ OF PERMITTEE OF ALIDATION ROBERT A. WOOD c M.0. CASH q SLIFE1iRVISINGgqMEgCHA�yNICALENpGGIIN7sEEER 28 ( _. _ , D CE808 APPLICATION FOR PERMIT E808 11-57 COUNTY OF LOS ANGELES �Y SEWER-SEWAGE- DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer CASSATT D. GRIFFIN. Sup t of Building LOCALITY- FOR APPLICANT TO FILL IN NEAREST CROSS ST.- LEGAL DESCRIPTION LOT NO.�Cj Vd7Z� ,I OWNER BLOCK /7 TRACT MAIL �/ ADDRESS C NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL.NO. USE OF - mpew BUILDINGS DISTRICT NO. I GROUP I MAP CONTRACTOR -....-+� P� B P6 ADDRESS f, fl. C7� CONNECTION DATA CITY 7• �9 TEL.NO.G r71 _ ION 6 DEPTH / STATE- ANHOLE REFERE CE PPER REGISTRATION N0. �� ^�� COUNTY NO. DESCRIPTION OF WORK FEE C HOUSE SEWER CONNECTING TO PUBLIC SEWER @ 4-a'� R?h TYPE OF CONNECTION LENGT ROM a1 O SEPTIC TANK.SEEPAGE PIT OR ' Y. CURB P.L. M.L.T P.L. Cs0) PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 Yao HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ $1.00 CO.I P.N0. JOB N0. CONNECT ADDITIONAL BLDG.OR Q VP WORK TO HOUSE SEWER @ $1.00 T ROAD PERMIT N ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMFWT PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT $ 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE ) REIMBURSEMENT FEE I HAVE AT DATE A CONTRACT WITH THE TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTItNGAMED DWELLIOG APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF )9_ NEW HOUSE SEWER OWNER OR A® CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) - AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL [I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. - ALTER,REPAIR,SEWER OR I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND CALIFORNIA OR THAT I AM THE LEGA OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTf PROPERTY. BACKFILL SEPTIC TANKS E]SIGNATURE SEEP. PIT(S ❑ CESSPOOLS El OF PERMITTEE OF VALIDATION ROBERT A. WOOD M.0. CASH SUPERVISING MECHANICAL ENGINEER ,L2 2 3 :O tn jkj 28 0 A 5eG:E�