HomeMy Public PortalAbout5611, 5613, 5615 ENCINITA AVE_Sewer__ . V
DEPARTMENT OF COUNTY ENGINEER ^SEWER—SEWAGE DISPOSAL
DIVISION OF rIW DING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER BUILDING
ADDRESS S�,i�-7
FOZAP3PLICANT TO_FILL IN LOCAury l� �f '
BUILDING NEARESTADDRESS ; ✓ 6/�i�4'^��!�M� CROSSST.LOCAL /, /1 /1 ,./^ I/ DISTRIT NO. A DIAL NO. PERMIT NO.
NEAREST /' A `/'/ Y A S
CROSS ST. ? r� CEIVED eV Reedy far Inspection 3G3�OWNERAIL
/
ADDRESS - 10 /j - USE ZONE OCCUPANCY MAP
/SS 5- Ar_ 4w ) ria' !/J ' BBKK PG
CITY / ✓�`�`� TEL.NO.�.r G-I^J -/ Ii CGOOD a _I / /
CONTRACTOR ,�(� /1' ),/�! P1 U Alb, NI CO.IMP. NO. 1 / 2
ADDRESS 5 F/n/57 JOB NO.
Y r
CITIQ/! F (�-'�✓f EL.N O./-7- rU 0r 7 TRUNK PERMIT NO.
/f i STATE _
REGISTRATION NO.LEGLp ® COUNTY ROAD PERMIT NO. ���� Z
OESCRAPTION LOT N0./ ,��- U r ,/L,� STATE ENCROACHMENT
w / wca Cl a 4�4.�� PERMIT NO.
BLOCK TRACT ✓ /� (� }' U II/� vim' / INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF SLOGS. -
NOW ON LOOT CHARGES
USE OF
BUILDINGS R cj I ; / �G/,�1( /,lei ./ /d f CONNECTIOMCHARGE FEE j
N0. DESCRIPTION OF WORK FEE
// HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
F' PUBLICSEWER @ $ 3.50 RECEIPTNO. /BOAT\ BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG.OR ,I XCEPTION RECORDED---
Z WORK TO HOUSE SEWER 1.00 QO
ALTER OR REPAIR EXISTING / NO. I - DATE By
_ SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM LOD - CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00': _ STATION ''JL4�' QI DEPTH K/
CESSPOOL—DRYWELL Y
SPECIAL CONDITIONS ONLY 2.00 I M1fANNORLLERREF�%ENCE/,( �� LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS- - -'PERMIT S `DO Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE hkJ2i
HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECT R'S SIGNATURE DATE
DWELLING TO THE PUB C SEWER
SIGNED THIS-
NEW OUSE SEWER H (AW
O W'NER OR CONNECT AODIT)ON AL
OWNERS AGEN A _ BUILDING OR WORK
.-_..-_ .. _. -.-- _
ADDRESS,.1.w�� �.{.! Ceok SEPTICTANAIN FIELEEP.D PIT(S)
v
+� - -- - --- - AND/OR DRAIN FIELD
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL 0 DRYWELL Q,
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
AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSESAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
EWER
ER OF THE ABOVE DESCRIBED RESIDEN IAL PROPERTY, BACKFILL SEPTIC TANKS
SEEP.PIT(S)0 CESSPOOLS
SIGNATURE
OF PERMITTEE -_-.---.-__--_
76AG42A 663 7/53