HomeMy Public PortalAbout5333 ENCINITA AVE_Sewer__ v
o DF.PARTDiENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS ��333 G
FOR APPLIC T TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST �wC:
DISTRICT NO SERIAL NO PERMIT NO
LOCALITY c/�' c
NEAREST Li-� _ ��// J
CROSS ST ;
REC&IVED B Ready for Inspection DATE ISSUED
OWNER MAIL JZ--
I J �
ADDRCSS 3 --_ 1 /U,S ZONA OCCUPANCY BK KAP PQ
CITY TE .+
CONTRACTOR
CO.IMP N0. 3 —7 7 1-1!9
ADDRESS , JOB.N0.
CITY EL N0. TRUNK PERMIT NO
STATE
REGISTRATION NO B COUNTY ROAD PERMIT NO �6�
LEGAL jrSTATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT42 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTOO NO OF BLDGS CHARGEb
NOW ON LOT
USE OF i
BUILDINGS CONNECTION CHAR E FEE
NO DESCRIPTION OF VORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER $ 350 RECEIPT NO DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTI N RECORDED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING NO ATE 18Y
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONNECTIOn DATA
SEPTIC TANK,SEEPAGE PIT OR ��'
PITS AND/OR DRAINFIELD 200 STATION � DEPTH
CESSPOOL—DRYWELL -e
SPECIAL CONDITIONS ONLY 200 ANHOLE REFERENCE
1 17 A7 4"�E*R < LOWER
TYPE 0 CTION LENGTH FROM
OWNERS PERMIT ; I I . 00 `Y� culls N L L TO P L �p
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTO SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER L_
SIGNED THIS ...DAY OF _19 NEW HOUSE SEWER
! �T CONNECT ADDITIONAL
0X*&M AGENT BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS V AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL E] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDE jj4I:—'PROPERTY BACKFILL SEPTIC TANKS E]
SIGNATURE Y SEEP PIT(S CESSPOOLS _ _ ��
OF PERMITTEE
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