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Home My Public Portal About5517 ENCINITA AVE_Sewer__ 6A64 f0-63 APPLICATION FOR PE MI 1° 76A642D COUNTY OF LOS ANGELES SEWER-S AGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS (�+ ! WILLIAM A. JENSEN, Supt of Building LOCALITY NEAREST FOR APPLI T TO FILL IN `ROSS ST. LEGAL DESCRIPTION LOT OWNER /V MAIL BLOCK TRACT ADDRESS NO. OF BLD S. SIZE OF LOT NOW ON LOT CITY TEL. NO. USEOIF DISTRICT NO. GROUP MAP P CESSED BY BUILD NGS o BK PG CONTRACTOR S ) � ADDRESS 3- ..i�� ,�l '� / _ + CONNECTION ATA P- 10' ST TION DEPTH CITY . 7E / UPPER P. STATE MANHOLE REFERENCE r �]p.}�•y�•. ,q/ REGISTRATION NO. �� ❑ COUNTY — NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR P C NO ' O PITS AND/OR DRAINFIELD @ $10.00 CO.IMP. NO. JOB NO. U A' HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 0 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD. INSI NO. DATE WORK TO HOUSE SEWER @ $3.00 U OVERFLOW SEEPAGE PIT,DRAINFIELD W EXT N.,C ES SPOO L,DRYW ELL,MANHOLE @ $5.00 ICL ALTER.REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING H SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL / OWNERS PERMIT $ 2 Oo CONNECTION CHARGE FEE CHARGES AUTHORIZATION TOTAL FEE 'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE C INSPECTOR*S SIGNATURE/ SIGNED THIS DAY OF 19_ 6, '.,• ! y�Gi OWNER OR NEW HOUSE SEWER,[,._ OWNERS AGENT CONNECT ADDITIONAL } BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTE ED AND/OR ALTER, REPAIR.SEWER OR LICENSED AS REQUIRED Y LOS ANGLES COUNTY D STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT A THE LEGA NER OF, NO INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A VE ESCRIBE� ENT L OPERTY. ABANDON HOUSE SEW ER SIGNATURE ACKFILL SEPTIC TANKS F-1OF PERMITTE SEEP,PITS) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER -^� 0 1 1 - I �r I— 1 .� �•..�J ..t'e1 � .✓ D (1�I„J tL ., 0-63 76A642D APPLICATION FOR PERMIT 6A642 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, Sup't of Building �+ LOCALITY 7- NEAREST FOR APPLI T TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT OWNER MAIL BLOCK TRACT ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS BK PG CONTRACTOR "'q 'c ADDRESS 3�tlD� _ - CONNECTION DATA CITY _ TEL. ST TION 1 DEPTH EY STATEUPPER MANHOLE REFE REGISTRATION NO, El NO. 6{ ! ' .. "9-'�'Lft•- NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. .� PITS AND/OR DRAINFIELD @ $10.00 CO.IMP.NO. JOB NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 Ix CONNECT ADDITIONAL BLDG.ORAFFIDAVIT WAIVER ESS EME NT RECORD. INSTR.NO. DATE O WORK TO HOUSE SEWER @ $3.00 V OVERFLOW SEEPAGE PIT,DRAINFIELD it EXTN.,CESS ,DRYWELL.MANHOLE @ $5.00 ALTER,R OR ABAND HOUSE HWY. OR ST.WIDENING SEWER ISP OSAL Y Efi1 @ $3.00 STATE ENCROACHMENT z PERMIT NO, INDUSTRIAL WASTE APPROVAL - OWNERS PERMIT s 2 00 CHARGES AUTHORIZATION TOTAL FEE y CONNECTION CHARGE FEE '1 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 INSPECTOR'S SIGNATURE SIGNED THIS OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL 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 LICENSED AS REQUIRE Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THA AM HE LEGAL OW OF, N INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A VE SCRIBED RESI�'E IAL RO RTY. ABANDON HOUSE SEWER SIGNATURE OF PERMITTE .� BACKFILL SEPTIC TANKS El ❑ S) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O, CASH