HomeMy Public PortalAbout5607 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 ADDBUILDRESS (p ING &6
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FOR APPLICANT TO FILL IN LOCALITY Zinip/P C/�I-U
BUILDING NEAREST B�dw�� �1 !!�[two 0q
ADDRESS CROSS ST k4,^,,
LOCALITY DISTRICT NO SERIAL NO PERMIT NO.
NEARES A 23oc/ 32 5-W S
CROSS ST
RECEIVE/DJ BY Ready for Inspection DATEISSUED
OWNER �
MAIL211-b USE ZONE OCCUPANCY MAP
ADDRESS BK PG
CIT TEL N
CONTRACTO M
CO.IMP NO
ADDRESS/� &1
JOB NO
CITY TEL N0 TRUNK PERMIT NO
STATE
REGISTRATION NO .COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO G! STATE ENCROACHMENT
dv PERMIT NO
BLOCK TRACT INDUSTRIAL
J NO OF BLDGS WASTE APPROVAL
SIZE OF LOT �Q X1z X NOW ON LOT CHARGES
USE OF 1417
BUILDINGS CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO-
REIMBURSEMENT FEE,,
HOUSE
@ S 350 3 RECEIPT NO I DATE I 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 NO DATE BY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD, 200 STATION O ARE, 7n - DEPTH
CESSP00 L—DRY W ELL
SPECIAL CONDITIONS ONLY 200 MANHOLEREFERENCE� LOWER
_ - R -a�,.. � GAJ o
TYPE OF CONNECTION LENGTH FROM /
PERMIT $ 1 00 Y CURB P L M C TO P L
_ OWNERS �
AUTHORIZATION TOTAL FEE_ //,) 12q,
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE-ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER' APPROVALS INSPECTOR'S SIGNATURE DATE
-
SIGNED THIS, _ _C_--DAY OF /� _ _ _ -_�19____ NEW HOUSE SEWEROWNER ()
ONAL
OWNERS AGENT s�':-W � GGf/1� /?D 4? Y BUILDICONNENG
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BUILDING OR WORK
SEPTIC TANK,SEEP PIT(S)
ADDRESS _ - — - AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT-1 HAVE,READ THIS APPLI- CESSPOOL E] DRYWELL❑
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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE
S ', . SEEP PIT(S)E] CESSPOOLS E]
Q
OF PERMITTE - _ _ __ ✓
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