HomeMy Public PortalAbout5435 ENCINITA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX, COUNTY ENQINEER BUILDING
ADDRESS
FOR APPLICANT T IjL IN LOCALITY
BUILDING /� r NEAREST
ADDRESS 3 CROSS ST
LOCALITY DISTRICT NO SERIAL NO PERMIT NO.
CRASS ST 6-- A 3 6S-D S
R EIVED BY Ready for Inspection DATE ISSUED
OWNER /O_/_s";�r
MAIL12 USE ZONE OCCUPANCY -_Mlw
ADDRESS //�� BK PG
CITY Q_ . TEL NO k,—/
CONTRACTOR /� CO.IMP NO
ADDRESS� rJ� JOB.NO
CITY EL NO — a7 TRUNK PERMIT NO
STATE 4201_�
REGISTRATION NO GJ Z 79 4 G COUNTY ROAD PERMIT NO 0 '?b
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT 7 Cj �p WASTE APPROVAL
USTRIAL
ON
SIZE OF LOT O /O NO LOTS �� 0 CHARGES
vi NOW ON LOT
USE OF
BUILDINGS CONNECTIONCHARGE F�E
DESLFENO CRIPW �
REIMBURSEMENTFEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $ 350 � t�� RECEIPT NOI DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
/ CONNECT ADDITIONAL BLDG OR EXCEPTION'RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING NOyI DATE BY
SEWER OR DISPOSAL SYSTEM 1 00 I I
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 200 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 D MANHOLE REFERENCE
4"'Im'R— LOWER
TYPE OF CONNECTION LENGTH FROM p� t
V-- CURB ..8-L-- M L.TO P L cl
OWNERS 11
00
AUTHORIZATION TOTAL FEE 4 1 SO
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED If
CONTRACTOR TO CONNECT THE ABO E DESCRIBED EXISTING APPROVALS INSPEC OR'881GNATURE DATE
DWELLING TO THE PUBLIC SEWE
SIGNED THIS DAY O�_ _ 6 � 19�/_ NEW HOUSE SEWER It ,
OWNER OR - CONNECT ADDITIONAL
OWNERS AGE _ _ _ BUILDING OR WORK
SEPTIC TANK :SEEP.
ADDRESS ARDOR DRAINFIELD PIT(S)
1 HEREBY ACKNOWLED -
GE THAT I HAVE AD THIS APPLI- CESSPOOL E] DRYWELL E]
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
PND/OR LICENSED AS R IRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFO A OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE CRIBEO ESIDENTIAL PROP TY BACKFILL SEPTIC TANKS I]
SIGNATURE / SEEP PIT(S)E] CESSPOOLS
OF PERMITTEE
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