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Home My Public Portal About5317 ENCINITA AVE_Sewer__ fla a I q 1A642D 2"° 76APPLICATION FOR PERMIT 76� 6 � COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL V DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING /� > JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS. % Al COLEMAN W JENKINS, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST (PRINT OR TYPE ONLY) LEGAL Q DESCRIPTION LOT NO OWNER c MAIL BLOCK TRACT ADDRE55S-3 7 . r., V 777q NO OF BLDGS SIZE OF LOT NOW ON LOT CITY /%, TEL NO USE OF BUILDINGS DISTRICT NO ROUP CLASS MAP PROCESSED BY � If BK 60NTRACTOR ADDRESS CONNECTION DATA l� CITY TEL NO STATION DEPTH STATE LIC MANHOLE REFERENCE UPPER LICENSE NO CLASS LOWER NO I DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L M L TO P L PUBLIC SEWER @ 55 00 PC NO SEPTIC TANK SEEPAGE PIT OR JOB NO PITS AND/OR DRAINFIELD $1000 CO IMP NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO d PRIVATE DISPOSAL SYSTEM +.$3 00 O CONNECT ADDITIONAL BLDG OR AFFIDAVIT INAIY[R E"5 .IMT RECORD TR NO DATE U WORK TO HOUSE SEWER @ 53 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 HWY OR ST WIDENING - O 74PR�f/ii ABANDON HOUSE .�vl 86MIQI�I�R.0I SPOSAL SYSTEM @ $3 00 �3 7J 0 STATE ENCROACHMENT V PERMIT NO Lu 0- INDUSTRIAL INDUSTRIAL h WASTE APPROVAL Z_ CHARGES OWNERS PERMIT s 2 .Ooy AUTHORIZATIONI TOTAL FEE CONNECTION CHARGE FEE _ I HAVE AT THIS DATE A CONTRACT WITH 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 TANK SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD ANO STATE,THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPER Y REGISTERED AND/OR ALTER,REPAIR SEWER OR LICENSED AS REQUIRED BY LOS NGLE COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE GAL NER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESC ED R DENTI PROPERTY ABANDON HOUSE SEWER •SIGNATURE BACKFILL SEPTIC T S ❑ It OF PERMITTEE SEEP PIT(S) ESSPOOLS 5 + VALIDATION JA c ALLEN CM O CASH SUPERVISING MECHANICAL ENGINEER K 4 D r, 2 Z 6A 642D 2/70 APPLICATION FOR PERMIT 76A 6 ' COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION gBUILDING DDRE7 -:.5/7TJOHN A. LAMBIE, COUNTY ENGINEERCOLEMAN W. JENKINS. SUP T OF BUILDINGLOCALNEAREF R APPLICANT O FILL IN CROSS E (PRINT OR TYPE ONLY) LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS /WC I" NO OF BLDG5 //�� `` q SIZE OF LOT NOW ON LOT CITY 1:`/n/yfI+L` L NO ' Z 3,9Z— USE L USE OF BUILDINGS DISTRICT NO P CLASS MAP CE SSED BY aJ[G� B K///��///�� P S GONTRACTOR �• DU / / /y ` M/J - _ ADDRESS �y CONNECTION DATA CITY /C �J�E EL NOG - 3�Z STATION DEPTH STATELIC GLA65 C 3 MANHOLE REFERENCE / 3 2 LOWER LICENSE NO NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURE P L M L TO P L PUBLIC SEWER @ 4. 1 Q Q SEPTIC TANK SEEPAGE PIT OR PC NO PITS AND/OR DRAINFIELD $1000 CO IMP NO �3 T7 JOB NO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO a PRIVATE DISPOSAL SYSTEM E3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER I-EASEMENT RECORD INSTR NO DATE O WORK TO HOUSE SEWER @ $300 V OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING O SEWER OR DISPOSAL SYSTEM @ 53 00 STATE ENCROACHMENT W PERMIT NO 0- INDUSTRIAL INDUSTRIAL N WASTE APPROVAL Z Q CHARGES OWNERS PERMIT s CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 'o 1"o d, I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE IN CTOR S S NATURE SIGNED THIS DAY OF 19 OWNER OR NEW HOUSE SEWER OWNERS AGENT _ CONNECT ADDITIONAL ADDRESS BUILDING OR WORK I HEREBY ACKSEPTIC TANK SEEP PIT(S)NOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS - CESSPOOL ❑ DRYWELL ❑t I HEREBY CERTIFY THAT I AM PR PERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS A LES C UNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE L AL OW R OF�LP AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE E&CR RE TERTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMfTTEE SEEP PIT(S) ❑ CESSPOOLS ❑ n—v ALIDATION JACK R. ALLEN (I M 0 CASH SUPERVISING MECHANICAL ENGINEER