HomeMy Public PortalAbout5635 ENCINITA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER �. '- SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING- AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES '
WILLIAM J. FDX; COUNTY ENGINEER •II ABUILDIDDRESNSG
FO_ (=AR APPLICANT TO FILL IN LOCALITY c
BUILDING 1 //�� CNEAREST
ADDRESS CROSS ST.
/7�1p /1 /' DISTRICT.NO: SERIAL NO.-, I �� 'PERMIT NO.
LOCALITY �! �♦ �j
NEAREST \ - ~
CROSS ST.
RECEIVED BY • ,'Ready for Inspection. DATEISSUED
OWNER I-A
MAIL n USE ZO NE OCCUPANCY' MAP
ADDRESS } �/pliLli.p: - - - OK PG
CITY / j
TEL NOgr ^Q gam ' - / 7-
CONTRACTOR
I'�/ 1 CO.IMP. N0.
ADDRESS �? JOB NO.
CITY.4 e _ TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. a COUNTY ROAD PERMIT NO.
LEGALROACHMENT
STATE ENC
DESCRIPTION LOTNO. I . STATE NC
v
BLOCK TRACT ?j-�G(.I,f INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 4_7 ( ND.0LOGS. CHARGES
NOW LOT
USE OF '�A,
BUILDINGS Y.� CONNECTION CHARGE FEE '
NO. DESCRIPTION DA WORK FEE -
REIMBURSEMENT FEE
NOOSE SEWER CONNEC INGSO
PUBLIC SEW ER @ 5 3.50 � S LJ RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE.DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLOC..OR EXCEPTION RECORDED
WORK TO HOUSE SEWER ' - ' "COO - - NO. DATE BY ` { -
ALTER OR REPAIR EXISTING
_SEWER OR DISPOSAL SYSTEM 1.00 I J.
'DISCONNECT AND ABANDON SEWER - - -
AND/OR DISPOSAL SYSTEM - - 1.00 - CONNECTION DATA -
SEPTICTANK,SEEPAGE PIT OR `
_ PITS AND/OR GRAINFIELD -2.00_ - .'STATION ^q f-" D DEPTH e7 /
CESSPOOL—DRYWELL ' /J� Mq
SPECIAL CONDITIONS ONLY 2.00 -�` ..% / .SD17 HOPPER EFERENCE LOWER'
_ _TYPE OF CONNECTION LENGTH FROM -
OWNERS PERMIT $ 1 00 w. /cu RB T rM.L.TO P:C.'
-AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HER N NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIG NATURE DATE
DWELLING TO THE PUBLIC'SEWER
SIGNED THIS--------------------DAY OF......_......_...__...............19....... NEW HOUSE SEWER V/6Pn.✓/Lw/� ///G
OWNER OR CONNECT.ADDITIONAL - -
OWNERS AGENT...___.._.__._._..._.........._.__...._ ..._._ ----.._.------._ BUILDING OR WORK
I SEPTIC TANK,SEEP.PIT(S)
ADDRESS----------------.--------------_------------------------------------...................... AND/OR DRAINFIELD
'I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL E] "
CATION AND STATE THAT THE ABOVE IS CORRECT'ANO 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.THEABOV .DESCRIBED RESIDENTIAL,PROPERTY. _ BACKFILL SEPTIC TANKS
1 /I 1 SEEP.PIT(S)C] CESSPOOLS
SIGNATURE /::,r'VP,pir-.OF PERMITTE _..n._.. ._.:_....._S_e./.____r.."..._•._.......___--
7GA642A 663 7/53