HomeMy Public PortalAbout5425 ENCINITA AVE_Sewer__ 24650 INSERTS
CE606PERMIT
APPLICATION FOR .
76A842D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
Wneer
ILLIAOH M A. JENSEN, Sup. LAMBIE, 't ofnBluilding J
LOCALITY
NEAREST
FOR APPLICANT TO FILL LIN ceoSS ST.
—DESCRIPTION LOT N0./U `L'��`'� , � V ` !� OWNER MAIL '
BLOCK TRACT ,CSC ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF DISTRICT NO.EG.,ROUP MAP OCESSED BY
BUILDINGS - �BK
PG
CONTRACTOR � '-� ,j , d
ADDRESS L�c CONNECTION DATA
CITYC r TEL.N0. ION / DEPTH
'STATE MANHOLE REFERENCE
REGISTRATION N0./ G-`�L COUNTY OWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FFROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
O.
HOUSE SEWER CONNECTING TO P.C. 0.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. OB N0. r
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT NO. a
WORK TO HOUSE SEWER @ $1.00 U
SEWER REPAIR OSAL ABANDON HOUSE @ $1 OO STATE ENCROACHMENT at
PERMIT NO. p
INDUSTRIAL ']
WASTE APPROVAL W
CHARGES Val
OWNERS PERMIT $ A& CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE HEEINAMED CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS '7 DA OF 19_ NEW HOUSE SEWER
CONNECT ADDITIONAL
GENT/ / BUILDING OR WORK
ADDRESS i SEPTIC TANK,SEEP.PITS)
��-��-""""""��/��/ � AND/OR DRAINFIELD
I HEREB)/ACKNOWLEDGE THAT/1 HAVE READ THIS APPLICATION
AND STAT 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
1 HEREBY .CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE IAL PROP• Y. BACKFILL SEPTIC TANKS ElSIGNATURE G SEEP.PIT(S) El CESSPOOLS Els
OF PERMITTE em` t l r
1
®p VALIDATION ROBERT A. WOOD
CI. M.0. CASH SUPERVISING MECHANICAL ENGINEER
u
I
24650 INSERTS
CE606 APPLICATION FO f1 � E IT
76A642D COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Bu1LDINc�.
ADDRESS
WILOLIA.AM A.JJENSEN,County ofnBuild ng
LOCALITY
-a.. :... : ..; NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
l G �
DESCRIPTION LOT N0. Ay OWNER ;
MAIL ~
BLOCK TRACT ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF y,) DISTRICT ANOGR�F' MAP PROCE ED BY
BUILDINGS J BKS PG
' CONTRACTOR'
ADDRESS /. " CONNECTION DATA
,F
CITY5'4 J EL.N0. S ION DEPTH /
STATE MANHOLE REFERENCE
REGISTRATION N0. COUNTY e LOWER
NO. DESCRYP'MON OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM /
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P M.L.TO P.L.
ITS 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. N0. JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. 0
WORK TO HOUSE SEWER @ $1.00
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT p[
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT N0, p
INDUSTRIAL U
WASTE APPROVAL W
a
CHARGESrA
rA
OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE Cz'L" REIMBURSEMENT FEE
"- I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING kj APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. j
SIGNED THIS / DAY OF 19_ '+ NEW HOUSE SEWER
esu /�j�_ CONNECT ADDITIONAL
rD.
OWNERS AGE N�£�� ' ��.'. -� BUILDING ORMORK -
SEPTIC TANK,SEEP.PIT(S)
ADDRESS
_ AMD/OR DRAINFIELD
I HERE ' 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 CERTIFYTHAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE E ❑
DESCRIBED RESID BACKFILL SEPTIC TANKS
IAL PROPE TY. SEE .PIT( ❑ CANKS LS ❑
SIGNATURE _
OF PERMITTEE
OF VALIDATIO ROBERT'A. WOOD
QK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
`-I _ _ U
5.
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