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Home My Public Portal About5417 ENCINITA AVE_Sewer__ c, CE808z° APPLICATION FOR � ERMIT ceeos a ae COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS MaMM JOHN A LANIBIE, County Eng�e" CASSATT D GRIFFIN, Sup t of Bwld.aq LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO v OWNER BLOCK TRACT MAIL '7 ADDRESS NO OF BL GS SIZE OF LOT NOW ON LOT CITY �^ TEL NO ' USE OF BUILDINGS DISTRICT NO GROUP I MAP I PROCESSED BY BK PG CONTRACTOR ADDRESS CONNEC ION DATA CITY OifrA L NO STATION DEPTH STATE MANHOLE REFERENCE UPPER REGISTRATION N COUNTY No DESCRIPTION OF WOR - FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ E3 00 TYPE OF TION LENGTH FROM SEPTIC TANK SEEPAGE PIT OR Y CURB P L M L TOP L PITS AND/OR DRAINFIELD @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL @ $2 00 HOUSE SEWER CONNECTING TO P C NO 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 STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $100 PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNER'S PERMIT $ 1 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE _5-16REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DjTE A INSPECTOR S SIGNATURE TO THE PUBLIC SE,M1IE SIGNED THIS DAY OF 19 NEW HOUSE SEWER le7��1 �NlU OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK OWNER OR ADDRES a SEPTIC TANK SEEP PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL 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 ABANDON HOUSE SEWER Y CALIFORNIA OR THAT AM THE L GA OWNER OF THE ABOVE / DESCRIBED RESIDEN ROPER f. SEEP BACKFILL SEP❑ CESSPANKS ❑LS A�l A,,,�; SIGNATURE _ OF PERMITTE ®' (9AUDATION ROBERT A WOOD < m o CASH SUPERVISING MECHANICAL ENGINEER scl77111=13 WG'4221 0 P 5.00 (` &zq CE8083 62 APPLICATION FOR PERMIT 76A642D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING / JOHN A LAMBIE County Engineer ADDRESS /Y WILLIAM A JENSEN, Sup t of Building L LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST LEGAL DESCRIPTION LOT NO OWNER U MAIL BLOCK TRACT ADDRESS C J , NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OFDIST C RICT N GROUP MAP PROCES D BY BUILDINGS 4 /� `✓ CONTRACTOR {v �/ 17 ADDRESS x s L�/ A31Rerl P4, CONNECTION DATA CITYTEL NO a STATION DEPTH _ 77// STATE UPPER REGISTRATION NO Q W COUNTY MA HOLE FER C LOWER NO DESCRIPTION OF WORK FEE TY E UF CONNECTION LENGTH RO HOUSE SEWER CONNECTING TO Y CURB P L _ML TOPIL PUBLIC SEWER @ $5 00 PC NO SEPTIC TANK SEEPAGE PIT OR t' PITS AND/OR DRAINFIELD @ $1000 CO IMP NO .108 NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIVER I EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $3 00 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR QISPQSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERKIf S 2 Oo AUTHORIZATION TOTAL FEE � 0%"VCONNECTION 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 SEPTIC TANK SEEP PIT(5) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I A HE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE LRISED RE ENTIAL OPERTY ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS E3SEEP PIT(S) ❑ CESSPOOLS ❑ cKVALIDATION ROBERT A WOOD M O CASH SUPERVISING MECHANICAL ENGINEER L,` ,o 8 6 4 5 DEC 19 1 0 D 5.00—