HomeMy Public PortalAbout5322 1/2 ENCINITA AVE_Sewer__ 76a842D
&E•889 1f-97 APPLICATION FOR PERMIT-
DIVISION
ERMIT
S 7
DIVISION -OF BUILDING AND, SAFETY ' S EW E R-S EwAG E-DISPOSAL. g
Deportment of.County Engineer,
- County of Los Angele8 BUILDING
,. JOHN A:-LAMBIE. COUNTY ENGINEER ADDRESS',7•�' y �C1w r2
® CASSATT•D GRIFFIN, SUPT OF BUILDING •LOCALITY ./
NEAREST `
FOR APPLICANT TO FILL IN ceoss sr.
LEGAL ` 1' e
DESCRIPTION LOT NO. D _OWNER
'MAI'L '-'
BLOCK TRACT `• � 2 ADDRESS
'/D v NO. OF BLDGS. CITY TEL. NO. 3
SIZE OF LOT L6 NOW ON,LOT �
USE OF t
BUILDINGS._ ^]7 DISTRIC O. GROUP- MAP
_ /yam P
CONTRACTOR. S w c , •y l
aDORess ' - i CONNECTION DATA
/� 'STATION 3, DEPTH
CITY SZ�,yl STEL. N0. 'r (/_/14;? l - 'UPPER
`I MANHOLE REFERENCE
kr'STATE�/ Qa/ - ❑ 'LOWER
REGISTRATION NO COUNTY
NO DESCRIP IO OF WORK FEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM - -
'PUBLIC SEWER - @ $3.50 Y. CURB P L.. M L.TO P.L.
SEPTIC TANK,SEEPAGE PIT OR 2 /
PITS AND/OR DRAINFIELD 147,37-6
�@ $3 00 v 6 G 7_
OVERFLOW SEEPAGE PIT,DRAINFIELD - - P. C. NO., ,
EXTN ,CESSPOOL,DRYWELL,MANHOLE @ $2 00 CO. IMP NO. JOB NO.
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM Q $1 00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG OR pv' •STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 '1 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL ,O
SEWER OR DISPOSAL SYSTEM Q $1 00 WASTE APPROVA '
ES
{ - - -- - - CONNECTI HARGE FEE '
OWNER'S PERMIT 00
- REIMBURSEMENT FEE
AUTHORIZATION- ' TOTAL 'FEE ,
I HAVE AT THIS;DATE A 'CONTR'A'CT WITH THE HEREIN NAMED CON- APPROVALS, DATE I NSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE`ABOVE DESCRIBED EXISTING DWELLING -
TO THE PUBLIC SEWER •NEW HOUSE SEWER
SIGNED THIS�6DAY OF 1 CONNECT ADDITIONAL
OWNER OR ' `- 'BUILDING OR WORK
' OWNERS AGENT
r SEPTIC TANK,SEEP„PLT(S)
ADDRESS • OD/OR DRAINFIELD -
1 HERE Y 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 e _ SEWAGE DISPOSAL SYSTEM'
1 HEREBY CERTIFY THAT, -1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND - -
LICENSED AS REQUIRED BYLOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA M THE L NER OF THE ABOVE -
DESCRIB ESIDE I PR ER BACKFILL SEPTIC TANKS'❑
SIGNAT R_E •-' SEEP PIT(S) ❑ CESSPOOLS❑
,OF PE
JOHN-X.' LAMBIr COUNTY ENGINEER - ROBERT A. WOOD. CHIEF PLBG INSPECTOR
C�ALIDATION
Al O CASH
3.0 0
6 ASO 6..2 7 7.0 GGT 3.1 .10 . A• m