HomeMy Public PortalAbout5414 ENCINITA AVE_Sewer__ 7880APPLICATION FOR- PERMIT - 1
cseo8-8•Ise s-sCOUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
CASSATT D. GRIFFIN, Supt of Buildmg, LOCALITY
NEAREST
FOR APPLI T TO FILL IN CROSS ST
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT MAIL
ADDRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DIST CT N GROUP MAP CESS BY
^ BK P6
CONTRALTO O
ADDRESS ONNECTION DATA
CITY r7 EL ` A DEPTH
ff��COUN MA 0 REFERENCE UPPER
REGISTRATION NO COUNTY
No DESCRIPTION 07 MRK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3 00
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION 314tNGTH FROIr
PITS AND/OR DRAINFIELD Q $3 00 Y CURB P L M L ATO P L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 CO IMP NO JOB NO
CONNECT ADDITIONAL BLDG OR TRUNK PERMIT NO ROAD PERMIT NO
WORK TO HOUSE SEWER @ $1 00
ALTER, REPAIR OR ABANDON HOUSE ACHMENT
S WER OR DISPOS L SYSTEM $1 00 ERMIT
DUST
!
CHARGES
OWNERS PERITT $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER
SIGNED THIS AY OF Ig_ NEW HOUSE SEWER r
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS41Z tttadSEPTIC TANK SEEP, PIT(S)
AND/OR DRAINFIELD
I HEREBY AC 0 LE GE THAT 1 HA READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL El
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS SEWAG DISPOSAL SYSTEM
1 HE EBY CERTIFY AT 1 AM PROPE Y REGIST AND/ ECT PLUG AND
LICEN AS RE BY ANGEL COUNTY STAT ABOOON HOUSE SEWER
CALI T — E
DES B 51 E KFILL SEPTIC TANKS❑
SIG T EpPITS [IC SSP00
0 P ITTE1104 1�44
®� VALIDATIROBERTA-WOOD,
�y g p, SUPERVISING MECHANICAL ENGINEER
1 1 ' -JuiN 2 2 1 1 A 2 5.0 0 �°
D
5 a E-683 3 99
APPLICATION FOR PERMIT" 1
& •B
DMSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of-County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
` CASSATT D GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLIC T TO FILL IN CROSS s
12 A
LEGAL
DESCRIPTION LOT NO OWNER
BLOCK TRACT MAIL
ADDRESS
NO OF BLDGS
SIZE OF LOT NOW ON LOT CITY TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP SK MAP PG
CONTRACTOR c _L Z
ADDRESS ONNECTION DATA
CITY TEL NO �� D!J-� STA 1 N• DEPTH
0--S'fATE MANHOLE REFERENCE CPE
REGISTRATION NO ` '��0�/j,� ❑ COUNTY
No DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO T PE OF NECTION LENGTH FROM
Y CURB
P L M L TOP L
PUBLIC SEWER Q $ 3 50
DOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100 _
CONNECT ADDITIONAL BLDG ORP C NO
WORK TO HOUSE SEWER 1 00 CO IMP NO JOB NO
ALTER OR REPAIR EXISTING �'�j3�
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT N �"�.(x,
\ DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1 00 PERMIT NO
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2 00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 200 CHARGES
CONNECTION CHARGE FEES
OWNER'S PERMIT $ 00
AUTHORIZATION I TOTAL FEE- REIMBURSEMENT FEE
IHAVE CON-
TRACTORTTOS CONNECT DATE O THE ABOVE WDESCRIBED EXISTING ITH THE HEREIN A DWELLING APPROVALS DATE INSPECTOR S SIGNATURE
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS D_AY OF 19-
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT 06
BUILDING OR WORK
SEPTIC TANK, SEEP, PIT(S)
ADDRESS �_ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[3AND 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
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQ IRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR AT
1 dHEAL OWNER THE BOVE ABANDON HOUSE SEWER
E5CRIBED RESID �ERTY ACKFILL SEPTIC TANKS❑
�p EP PIT(5) SPO? S Cl
OF PERM
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION (20A WOOD. CHGe1A sp C OR
LAC'o 5 3 0 9- JUS! 2 2 1 0 A 5.0 0