HomeMy Public PortalAbout5547 ENCINITA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER i I BUILDING
ADDRESS 5547
FOR APPLICANT TO FILL IN LOCALITY Tag ill r/14-11
BUILDING NEAREST 5n0 &j�� � 4Ve &/ A__ _
ADDRESS CROSS ST /d �[ /G �[{/�IKl(
LOCALITY ! DISTRICT NO SER�IAL�NO PERMIT NO c
NEAREST A 13go -3-1 g G J
CROSS ST
RECEIVED BY Ready for Inspection DATEISSUED
OWNER
MAIL USE ZONE OCCUPANCY
ADDRESS MAP
BK PG
CITY ' TEL NO
CONTRACTOR �C
CO.IMP NO /
ADDRES3,*,f// JOB NO F �(p/
CITY TEL NO�� � TRUNK PERMIT NO
REGISTRATION NOCOUATE NTY —
ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT INDUSTRIAL INDUSTRIAL
NO OF BLDGS WASTE APPROVAL
SIZE OF LOT Q NOW ON LOT - CHARGES
USE OF � ,
BUILDINGS CONNECTION CHARGE FEE [ t
N0.1 DES RIPTION OF WORK i FEE
HOUSE SEWER CONNECTING TO `REIMBURSEMENT FEE
PUBLICSEWER 0 $ 350r 3 Jv— RECEIPT NO I DATE IBY ,
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 100' "
ALTER OR REPAIR EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 1 00 I _
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM', 1 00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION /2 / / / D DEPTH
CESSPOOL—DRYWELI �-'1 i0
SPECIAL CONDITIONS ONLY 200 L /� MANHOLE REFERENCE
UPPER LOWER-
TYPE OF CONNECTION LENGTH FROM , ',—
OWNERS PERMIT $ 1 00 Y — CURB -- PL ✓M L TO P L
AUTHORIZATION TOTAL FEE
IHAVE 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 .. ____ _ _ _ .___19__-._ NEW HOUSE SEWER 2�iYr9
OWNER OR A14 � ��r,-Z, ,��L1.e.�' CONNECT ADDITIONAL
OR WORK OWNERS AGENT_ "'���[[f
SEPTIC TANK,SEEP.PIT(S)
ADDRESS _ - - - _ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE-THAT I HAVE READ 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
I HEREBY CERTIFY THAT I AM 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 DESCRIBED RESIDENTIAL PROPERTY ,BACKFILL SEPTIC TANKS ` (I
SEEP PIT(S)C] CESSPOOLS 1:1( car 2 S 3
SIGNATURE moi/ "��/�K --
OF PERM ITTE6A��
76A642D 663 1/53