The URL can be used to link to this page

Home My Public Portal About5465 ENCINITA AVE_Sewer__ w 76A84 1x_82 APPLICATION FOR PERMI CE 08 1 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A LAMBIE County Engineer ADDRESS WILLIAM A JENSEN Supt of Building / y LOCALITY NEAREST FOR APPLICANT TO FILL IN GRDBS BT LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK TRACT ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROl�9, MA�/�d PROCESSED BY BUILDINGS 1�/f�J 1,; BK CONTRACTOR V - ADDRESS CONNECTION DATA CITY TEL NO STATION DEPTH STATE MANHOLE REFERENCE UPPER REGISTRATION NO COUNTY LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y CURB P L Mi. TO P L V PUBLIC SEWER @ SS 00 C NO SEPTIC TANK SEEPAGE PIT OR J PITS AND/OR DRAINFIELD @ $1000 CO IMP NO OB NO rO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO tJ PRIVATE DISPOSAL SYSTEM @ $300 {{LLLJ CONNECT ADDITIONAL 8✓ i?^ AFFIDAVIT wAIV[F EASEMENT RECORD INSTR NO DATE a WORK TO HOUSE SEWER @ $300 f/L� yNy OVERFLOW SEEPAGE PIT DRAIN FIELD L EXTN CESSPOOL DRYWELL MANHOLE @ $5 00 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL �_��+ �+ WASTE APPROVAL OWNER'S PERM�FEE 2 OO CHARGES AUTHORIZATION TOTA , � /'fir/ CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED VCON 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 dl ADDRESS SEPTIC TANK SEEP PIT(S) � B I HEREBY ACKNOWLEDGE THAT I 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 ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR LICENSEDAS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN THE ABOVE DESCRIBED 2SIDENTIAL PROPERTY ABANDON HOUSE SEWER LSIGNATURE BACKFILL SEPTIC TANKS ❑ PERMITTEE SEEP PIT(S) El CESSPOOLS ❑ VALIDATI ROBERT A WOOD CK M 0 t-ASUPERVISING MECHANICAL ENGINEER CK M O H OLACO7 0 4% JUM30 1 0 ID 5.00 r 62 76A64262 APPLICATION FOR PERMI 6A842 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING //� /vc JOHN A LAMBIE County Engineer ADDRESS �Y WILLIAM A JENSEN, Supt of Building N /r LOCALITY NEAREST FOR PPL TO LIN `ROSS ST LEGAL 1) DE CRIP I N L6T O 4 e. '9'��a OWNER ll , MAIL BLOCK TRACT ADDRESS W0^&F BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF DISTRICT NO GROUP MAP PROCE E Y BUILDINGS BK PG /� ,�y�r/�� L✓ CONTRACTOR /) 1 ADDRESS lJ CONNECTION DATA CITY TEL NO C4L t_&eQ_ STATION r DEPTH �Q ' El STATE MANHOLE REFERENCE REGISTRATION NO `7 ❑ COUNTY 1 LOWER NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGT FROM HOUSE SEWER CONNECTING TO /� Y CURB P L M L TO P L PUBLIC SEWER @ $5 00 ff 0 7C PC NO SEPTIC TANK SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ 31000 CO IMP NO JOB NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT N PRIVATE DISPOSAL SYSTEM @ S300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT .1I ER I EASEMENT RECORD INSTR NO DATE WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT DRAINFIELD EXTN CESSPOOL DRYWELL MANHOLE @ $500 ALTER REPAIR OR ABANDON HOUSE HWY OR ST WIDENING SEWER OR DISPOSAL SYSTEM @ $3 00 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL OWNERS PERMIT $ z o0 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE I 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 INSPECTORIGNATARE, SIGNED THIS DAY OF 19_ �,' OWNER OR _ / NEW HOUSE SEWER OWNERS AGENT � L jI/�/� CONNECT ADDITIONAL r r BUILDING OR WORK ADDRESS SNo D IC'TANK SEEP PIT(S) ' 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION qND/ORIR'ATtV FhECD ^ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING LDE AND SEWERS CESSPOOL ❑ DRYWELL ❑ CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR S REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM OR THAT I AM THE LEGAL OWNER OF AND INTEND TO DISCONNECT PLUG AND THE AWOVESCRIBED RESIDENTIAL PROPERTY ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS ❑ TTEE SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A WOOD CK M O SUPERVISING MECHANICAL ENGINEER LAC0 X 5 0 91 Fes 2 8 1 0 D 7.00-- �'