HomeMy Public PortalAbout5432 ENCINITA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL.
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS `J J
FOR APPLICANT FILL IN LOCALITY
BUILDING NEAREST
ADDRESS
CROSS ST
LOCALITY DISTRICT NO' SERIAL NO PERMIT NO
NEAREST
CROSS ST
RECEIVED BY Ready for Inspection DAT ISSUED
OWNER �� �0 �Q
MAIL USE ZO OCCUPANCY y BK MAf PG
ADDRESS r
CITY TEL N0. �� ��� /2
CONTRACTOR r
CO.IMP.NO
ADDRESS r l �" S JOB.NO.
CITY TEL.NO,/—A TRUNK PERMIT NO —
REGISTRATION NO 3 Q ® STATE COUUNTNT
Y ROAD PERMIT NO
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO //�� PERMIT NO
BLOCK TRACT�/,5j1(//VyAGS�/ INDUSTRIAL WASTEINDUSTRIAL
APPROVAL SIZE OF LOT �7 x ! �j NO OF OW ON LOTS / CHARGES
USE DI r CONNECTION CHARGE FE
BUILDINGS /
NO DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
' HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 350 RECEIPT NO ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTION REC RDED
WORK TO HOUSE SEWER 1 00 / NO
ALTER OR REPAIR EXISTING DATE BY o
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAtNFtELD 2.00 STATIONDEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 7 +� "MA_ FERENCE LOWER
TYPE OFC CTIO� MEL TOHPFROM
OWNERS PERMIT 1 00 ,
AUTHORIZATION 1191 .v
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS. ___.DAY OF_ 0%A7'__...19C3 NEW HOUSESEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _.� -_ _ _ BUILDING OR WORK
�L _Y SEPTIC TANK,SEEP.PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL[:] DRYWELL
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 IAM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE ESCRIBED R SIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE �I/•�/� SEEP PIT(S)[] CESSPOOLS gCG YD 6—
OF PERMITTEE
76A642A 663 7/53 (d\"�