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HomeMy Public PortalAbout5443 ENCINITA AVE_Sewer__ D S&E-669 I1-55 Y APPLICATION FOR PERMIT 1 3&E-8 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER J_ ADDRESS ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS T. LEGAL OWNER � DESCRIPTION LOT N0. _ BLOCK TRACT/ 7 ADDRES� :3NO OF «� .. SIZE OF LOT. OX[ G NOW ONBLOTS CITY et. TEL. NO. t Z pI USE OF y�1, ll //`-/ DISTRICT NO. GROUP MAP BUILDINGS L `�'L t'� �Q fL ' BK PG CONTRACTOR ADDRESS I C,� CONNECTION DATA d��J3 r © J 'y STATION ✓ DEPTH CITY TEL. N0. + .:� O MANHOLE REFERENCE _ UPPER //_ STATE REGISTRATION NO. �S� �7 ❑ COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO TYPE CTION LENGTH FROM PUBLIC SEWER @ $3.50 Y. CUR P.1. M.L. TO P.L. SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELD .d o� / P. C. N0, . EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO,/ Off. c JOB NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM $1.00 TRUNK PERMIT NO. ROAD PERMIT N0.7 CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT $ 1 00 REIMBURSEMENT FEE s AUTHORIZATION TOTAL 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_ ��-`�/� NEW HOUSE SEWER SIGNED THIS- tom DAY OF 1y1� CONNECT ADDITIONAL OWNER OR ),, V^ BUILDING OR WORK - Y�✓�''' i"�'( SEPTIC TANK,SEEP,PITS) ADDRESS---g--y" AND/OR DRAINFIELD .I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND 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 1 HEREBY CERTIFY THAT IAM 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 RESIDENTI L PRO ERTYBACKFILL SEPTIC TANKS❑ . SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS OF PERMITT JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK, M. Q. ASH LAC0 4 6' 0 4 L SEP 1 0 1 A 550 /_