HomeMy Public PortalAbout5340 ENCINITA AVE_Sewer__ 76A642D Ai ■ LI 4IATION; FO ■ PERMIT ■
6 d E 663 12 64 u01
DMSION OF 13=ING AND SAFETY ' SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
WM J FOX, COUNTY ENGINEER ADDRESS / G
CASSATT D GRIFFIN, SUPT of BUILDINGMMM= -LOCALITY j-y,p!-
FOR APPLICANT TO FILL IN NEAREST l �-C
CROSS ST
LEGAL DESCRIPTION LOT NO OWNER VnENt 1
BLOCK TRACT
' /v d) _
ADDRESS 0 i&o d
SIZE OF LOT Q/( 2 )„Q NOW ON LOTS D/✓� CITY TEL NO - �3
USE OF �IIwgm
BUILDINGS 4"� / CIEs+,1 1 DISTRICT NO GROUP MAP
/ BK PG
CONTRACTOR Lu �� /J� J /�/�
ADDRESS I 124:5tVw CONNECTION DATA „1
CITY TEL NO STATION '�'� 7 DEPTH
❑ STATE ®•`t/ ,YjOrs -
REGISTRATION NO COUNTY MANHOLE REFERENCE LOWER
❑ Q L /`
TYPECURB ECTION LENGTH FROM /
NO DESCRIPTION OF WORK FEE Y P L M L TO P L
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3 50 , >L
HOUSE SEWER CONNECTING TO _
_ PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR CO IMP NOJOB NO
WORK TO HOUSE SEWER 1 00 tJ
ff
ALTER OR REPAIR EXISTING /70��
_ SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO a /
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK,SEEPAGE PIT OR
_
ITS AND/OR DRAINFIELD 2 00 INDUSTRIAL '
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2 00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
TRACTOR TTOSCONNECT THE AABOVECTED WDESCR BED EXISTINGITH THE HEREIN ADWELLIING CON APPROVALS DATE IN PECTOR'SSIGNATURE
TO THE PUBLIC ER
SIGNED THIS AY OF- 1 1
NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS BUILDING OR WORK
ADDRESS SEPTIC TANK, SEEP, PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL❑
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 SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCON ABANDON-HOUSE PL SEWER
CALIFORNIA OR THAT I AM THE LEGAL'OWNER OF THE ABOVE
DESCRIBED TIAL PROJPERTY,11 BACKFILL SEPTIC TANKS❑
��� ^ SEEP PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
ILLIAM J.,F , C UNTY ENGI R VALIDATION
�L 3BY3 5 0� MAY 3 44.5 0
DEPUTY DEPUTY _
BY
DEPUTY DEPUTY