HomeMy Public PortalAbout5323 ENCINITA AVE_Sewer__ F
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cE (RR 6/78) 1/79 APPLIC TION FOR P MIT
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SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
OR APPLICAO FILL IN DISTRICT NO GROUP MAP PR ESSED BY
BK PG
BUILDING
ADDRESS
LOCALITY
�s v CONNECTION DATA
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NEARE STATION �LJ DEPTH
CROS ST
U
MANHOLE REFERENCE J�✓L LOWER.
OWNER TYPE OF CONNECTION LENGTH F M
MAIL D Y, CURB M L TOP
ADDRE
Pc N
EL NO
CO IMP NO ./3 72 JOB NO
TY I Tr
LEGAL TRUNK PERMIT NO ROAD PERMIT NO
DESCRIPTION LOT NO
AFFIDAVIT I WAIVER I EASEMENT RECORD INSTR NO DATE
BLOCK TRACT
NO OF BLDGS
SIZE OF LOT /I NOW ON LOT HWY OR ST WIDENING
USE OF
BUILDIN STATE ENCROA E
PERMIT NO
CINDUSTRIAL
ONTRACTO
WASTE APPROVAL
ADDRESS CHARGES
CITY TEL N D- 8-705-6 CONNECTION CHARGE FEE
STATE 3 IL
LIC / REIM BU RSEMENT FEE
LICENSE NO CLASC
N DESCRIPTION OFe 99
ORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE V
HOUSE SEWER CONNECTING TO
PUBLIC SEWER NEW HOUSE SEWER 2r-�'^ J`�� 0
SEPTIC TANK SEEPAGE PIT OR
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PITS AND/OR DRAINFIELD CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO BUILDING OR WORK �.
PRIVATE DISPOSAL SYSTEM
CONNECT ADDITIONAL BLDG OR SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
WORK TO HOUSE SEWER
OVERFLOW SEEPAGE PIT DRAT NFIELD CESSPOOL ElDRYWELL C3
EXTN,CESS POOL,DRYWELL,MANHOLE
ALTER REPAIR OR ABANDON HOUSE ALTER REPAIR,SEWER OR
SEWER ORD SPOSAL SYSTEM SEWAGE DISPOSAL SYSTEM
DISCONNECT PLUG AND
ABANDON HOUSE SEWER
BACKFILL SEPTIC TANKS Cl
Permit s SEEP PIT(S)❑ CESSPOOLS❑
OWNER'S ALIDATION
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _ liJo
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING -
TOTHE PUBLIC SEWER
SIGNED THIS OF - 19 X91_ ,1.4A
OWNER OR
OWNERS AG ENT�� #'O O'O O 110
ADDRESS 210 0 1 D 0 0
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION pQ
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 1 ,° O O U
WITH ALL COU Y ORDINANCES AND STATE LAWS REGULATING BOO O
PLUMBING SEVERS + ,
I HER CERTIFY THAT I AM PROPERLY REGJISTERED A D/OR O 5`. 80 LIGENS AS REOU IRE. BY LOS ANGELES AND ST E OF
CALIF NIA OR THAT I AM THE LEGAL OWN F A INTEND O RE-
SIDE 1 THE ABOVE DESCRIBED RESID L PRO RTY
SIGNATU
OF PERMITTEE