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Home My Public Portal About5327 ENCINITA AVE_Sewer__ ,o.6p 76A642D APPLICATION FOR PERMIT 78A84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION [CROSS UILDING JOHN A. LAMBIE, County Engineer DDRESS WILLIAM A. JENSEN, Sup't of Building OCALITY fG EAREST FOR APPLICANT TO FILL IN ST LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT / ADDRESS NO OF BLDGS. ° SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS BK PG CONTRACTOR J�(J A . ADDRESS - �� CONNECTION ATA STATION DEPTH C Y ' EL NO PPER REGISTRATION NO 2� COUNTY MANHOLE REFERENCE .4 d No. DESCRIPTION OF WORK FEE TYPE OF CO TION LENGTH FROM O HOUSE SEWER CONNECTING TO Y U P L. M L TO P.L , V PUBLIC SEWER @ $5 00 P.C.NO. 99 SEPTIC TANK,SEEPAGE PIT OR NO J PITS AND/OR DRAINFIELD @ ¢1000 CO IMP. OB NO O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO A $300 PRIVTE DISPOSAL SYSTEM @ 1� CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER [I15EMENT RECORD.INSTR NO DATE N WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT.DRAINFIELD E%TN,C ESSPOOL,DRYWELL,MANHOLE @ $500 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ 2 00 CHARGES AUTHORIZATION TOTAL FEE /��j CONNECTION CHARGE FEE 1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DE CRI BED E)(ISTING DWELLING '"6 TO THE PUBLIC SE ' �J - APPROVALS DATE INSPECTOR; SIGNATURE SIGNED THIS iii_DAY OF N 19 OWNER OR ///��f 1/1 ,. // NEW HOUSE SEWER OWNERS AGENT I y I �.•4-Ci��GGC.� CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL [:1DRYWELL El 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REOUIR BY LOS ANGLES COUNTY AND STATE OF SEWAGEDI SPOSAL SYSTEM CALIFORNIA OR THA AM THE EGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB DE SC ED 5 DENTIA OPE RTY ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK M o cnsH SUPERVISING MECHANICAL ENGINEER LACO 3 3 6 1 QFC 1 1 1 0 D 7,Q Q N N, EBDB I 76A 642DD ,' APPLICATION FOR PERMIT 7 COUNTY''OF LOS ANGELES ' SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS (� COLEMAN W. JENKINS. SUPT, OF BUILDING ?--�c� LOCALITY NEAREST FOR APPLICANT TO FILL IN `ROBS ST. LEGAL w� DESCRIPTION LOT NO. OWNER CJ MAIL r BLOCK TRACT ADDRESS27 SLO SIZE OF LOT NOW OON LOOTS CITY •a! TEL. NO. USE OF DISTRICT NO. GROUP MAP CE68ED BY BUILDINGS BK PG CONTRACTOR SOg TOOT ADDRESS CONNECTION.DATA CITY TEL. NO STATION DEPTH STATE LIC MA OLE REFERENCE UPPER LICENSE NO CLASS LOWER NO, DESCRIPTION OF WORK FEE TYPE CONNECTION LENGTH FROM 1 HOUSE SEWER CONNECTING TO Y RB P.L M L TO P.L. ' ' PUBLIC SEWER 40 $5 00 SEPTIC TANK.SEEPAGE PIT OR P.C.NO. ! PITS AND/OR DRAINFIELD @ $1000 CO IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO >_ PRIVATE DISPOSAL SYSTEM @ $3 00 TRUNK PERMIT NO RO PERMIT NO. CL CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVE■ [AS[X[XT R R NSTR NO. DATE C)WORK TO HOUSE SEWER Q $300 C..7 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN,CESSPOOL.DRYWELL.MANHOLE 0 $500 CDALTER.iiGP�w�E?R�E"' - HOUSE HWY OR ST WIDENING V SEWER OR @ $300400 STATE ENCROACHMEN CL Lu I� PERMIT NO fn INDUSTRIAL Z �. WASTE APPROVAL CHARGES OWNER'S PERMIT S 2 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 1 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 I HEREBY ACKNOWLEDGE THAT, I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT_(S) A'N DOR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ElDRYWELL [II HEREBY CERTIFY THAT I AM PR ER REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSEDAS REQUIRED BY LOS A LES UNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE L AL O ER OF, D INTEND TO RESIDE IN, THE ABOV REST NT L OPERTY DISCONNECT PLUG AND ABANDON HOUSE SEWER _ SIGNATURE f BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ ATION JACK R. ALLEN SUPERVISING MECHANICAL ENGINEER CK 11-0 CASH _