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HomeMy Public PortalAbout5305 ENCINITA AVE_Sewer__ °-69 76AB42D APPLICATION FOR PERMIT 6A842 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING D j, JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt of Buildmg ___j IOCALiTY NEAREST FOR APPLICANT TO FILL IN CROSS ST / LEGAL DESCRIPTION LOT NO __ Q� OWNER MAIL BLOCK TRACT ADDRESS Os NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO �, USE OF BUILDINGS DISTRICT NO GROU MAP PROCESSED BY PG CONTRACTOR /L, _-0{,! ADDRESS CONNECTION ATA r CITY TEL NO STATION DEPTH REGISTRATION NO LJ COUNTY MANHOLE REFERTE ENCE ! LOWER NO _ DESCRIPTION OF WORK FEE TYPE OF CO ION LENGTH FR HOUSE SEWER CONNECTING TO ���� Y CURB P L M L TO P L �D d PUBLIC SEWER @ $5 00 UIV SEPTIC TANK,SEEPAGE PIT OR P C NO O PITS AND OR DRAINFIELD @ SIO 00 CO IMP NO JOB NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO w PRIVATE DISPOSAL SYSTEM @ S3 00 0 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER EASEMENT I RECORD INSTR NO DATE G WORK TO HOUSE SEWER @ S3 00 OVERFLOW SEEPAGE PIT,DRAINFIELD W EXTN,CESSPOOL DRYWELL,MANHOLE @ S500 a V) ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ 5300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SE APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DA F p �` —19� f OWNER OR NEW HOUSE SEWER /y OWNERS AGENT_� ` CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SANA SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM - CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER SIGNATURE / • OF PERMITTEE BACKFILL SEPTIC TANKS El.0 . SEEP PIT(S) ❑ CESSPOOLS ALIDATIO ROBERT A. WOOD j SUPERVISING MECHANICAL ENGINEER CK M O CASH ,LAt1 0 1 2 9 1 APR 15 1 0 0 7.0 0- COUNTY OF LOS ANGEiES • TEMPLE CITY # 0508 SEWER PERMIT 9 DEPARTMENT OF PUBLIC WWQQRKS 9071 LAS TUNAS SE 0508 9709190002 BUILDING AND SAFETY / LAND DIVELOPMENT TEMPLE CITY CA PHONE: (818) 285-0488 EXT: -LEGALSEWER SEPTIC: D ADDRESS: ON FILE EXIST OCC GRP: 5305 ENCINITA AV BLDGS. NOW ON LOT: TEMP CA 917803115 ASSESSOR - CONNECTION TYPE: NEAREST CROSS STREET: 5388-008-017- ORIGINATION: THOMAS PAGE: '596 GRID: J4 LOCALITY: TEMPLE CITY LENGTH ML TO PL: STATION: DEPTH: MANHOLE REFERENCE: UPPER/LONER: PROCESSED EXPIRES ON: 09/19/97 UT09 /98 COUNTY IMPROVEMENT NUMBER: OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL B CODE: SHAWVER A EDWARD (818) 287-4902- JOB NUMBER: 0 5305 ENCINITA AV TRUNK PERMIT NUMBER: TEMP 917803115 ROAD PERMIT NUMBER: CRIPTION AFFADAVIT: NO CONNECT NEW ADDITION TO HOUSE siwk WAIVER: NO EL. EASEMENT: NO SAME AS OWNER RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS: HIGHWAY/STREET WIDENI;NG:(fz (C- STATE ENCRO CHHMM NWRMI�T_NUBE R:`� CONTRACTOR: TEL. NO: �� �F � APPROVALS DATE INSPECTOR SIGNATURE SAME AS OWNER - LIC. NO FEE/,DESCRIPTION: QUANTITY,: AMOUNT: NEW HOUSE SEWER O11-PERMIX ISSUANCE FEE \\ �A 27.75 CONNECT ADDITIONAL 15zAL'V%REP HOUSE SEWER 1.00 EAC30.30 BUILDING OR WORK ARCHITECT TOTALl-FEES 58.05 SEPTIC TA SEEPAGE PIT LIC. NO: AND/OR DRAIN FIELD SEWER MAP BOOK: PAGE: P II [� �� /��© IAC REPAIR, SEWER OR U'Lou 1l V U SEWAGE DISPOSAL SYSTEM o DISCONNECT P o� O ABANDON HOUSE SEWER 0 — C T = n ®� SEEP. PIT CESSPOOL X'O GRAYWATER SYSTEM 19rva(ce REPORT ID: DPR266 ROUTE TO BS0508