Loading...
HomeMy Public PortalAbout5701 ENCINITA AVE_Sewer__ _ :, N .. _r' •-� . : tip ' e" CE0OBAPPLICATION FOR PERMIT '°A86$0D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION noonessG /VG ILHN A. LAMBIE, County En ineer I WILLIAM A. JENSEN, SuP t of Building LOCALITY G - NEAREST FOR APPLICANT TO FILL IN ceoss sr. Gf—rn.r r f✓ LEGAL - A'" DESCRIPTION LOT NO.,S -7,a tom-_�L? C1 OWNER ,.1, ( 3'� _ ! .. BLOCK TRACT - FF MAIL j NI r ADDRESS •i / / NO.OF BLDG$. --- SIZE OF LOT NOW ON LOT .I r CITY L --1 4E L. N0. USEOF ,� -- " BUI LOINGS +�_ i� �,_.�.�•'� DISTRICT NO. GROUP MAP PROCESSED BY �. / .. BK PG 'i /' CONTRACTOR , �1.. .z J.C• / I fry, tI I ! ..-ll./ ADDRESS r �' r �- i - CONNECTION DATA CITY �/A TEL-N0. ��..� /�.a/ /� !•� STATION � _ r� DEPTH STATE MANHOLE REFERENCE / ! UPPER REGISTRATION NO. r U COUNTY %/ LOWER NO. DESCRIPTION OF OR FEE — --•^ HOUSE SEWER CONNECTING TO i J PUBLIC SEWER @ $3.00 � TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y.\ CURB P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ 33.00 �� w OVERFLOW SEEPAGE PIT. DRAINFIELD O EKTN..CESSPOOL. DRYWELL @ S2.00 V HOUSE SEWER CONNECTING TO - P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. J ,., JOB NO. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0, ROAD PERMIT N0. W WORK TO HOUSE SEWER @ $1.00 ALTER, OREPAIR DISPOSAL SYSTEM HOUSE @ $I 00 STATE ENCROACHMENT PERMIT NO. G INDUSTRIAL p� WASTE APPROVAL FW$ CHARGES OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE t) REIMBURSEMENT FEE I HAVE AT DATE A CONTRACT THE HEREIN NAMED CN- TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE ! INSPECTOR'SSIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER 1:7 1," I/ 1- ��I�✓'I'� OWNER OR ` CONNECT ADDITIONAL OWNERS AGENT ��, -•'�"'"-'.�•� _HU LDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR 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 AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE. LEGAL OWNER OF THE ABOVE DESCRIBED RESIDEN A PROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATURE L SEEP. PIT(S) ❑ CESSPOOLS ❑ OF PERMITTE Lr •� '�y'� ©. VALIDATION ROBERT A. WOOD CK. M.0. usH SUPERVISING MECHANICAL ENGINEER awe-x,1246�INSERTS 1124650 INSERTS CEAOD Tape4 APPLICATION FOR PERMIT sD COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL . DEPARTMENT OF COUNTY ENGINEER �E BUILDING AND SAFETY DIVISION ADoaesSG ✓ Al G rAT JOHN A. LAMBIE. County Engqineer WILLIAM A. JENSEN, SuP't of BuirLlj LOCALITY G NEAREST FOR APPLICANT TO FAL. IN CROSS ST. �+ LEGAL ( DESCRIPTION LOT NO.S/� -] BLOCK TRACT N "l 13 _ I J MAIL ADDRESS X a W"w r N0.OF BLDGS. SIZE OF LOT NOW ON LOT CITY EL. NO. USE OF DISTRICT NO. GROUP - MAP PRO BY . BUILDINGS .� . BK PG CONTRACTOR `1•✓ (1 4- �✓'- ADDRESS ea 7 CONNECTION DATA CITY L �, TEL.NO. WN&C STATION _, G DEPTH {r STATE MANHOLE REFERENCE // ^p UPPER REGISTRATION NO. �.3 / O� ® COUNTY - br /L LOWER NO. DESCRIPTION OF WORK HOUSE SEWER CONNECTING TO - PUBLIC SEWER CO $3.00 k TYPE OF CONNECTION LENGTH FROMSEPTIC TANK.SEEPAGE - PITS AND/OR DRAINRELDT OR @ $3.00 Y. CURB P.L. M.L.TO P.L. OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN.. CESSPOOL. DRYW E LL @ E2.00 HOU5E SEWER C0NNECTI Ng TO J P.C.NO. PRIVATE DISPOSAL SYST EAt @ $1.00 CO. IMP. NO. I SJ 7 JOB NO. 9 Q CONNECT ADDITIONAL BLDG.OR @ TRUNK PERMIT NO. ROAD PERMIT N0. 960.�� V WORK TO HOUSE SEWER 31.00 SEWER ON SAS POSAL SYSTEM HOUSE @ $100 STATE ENCROACHMENT °E PERMIT NO. M INDUSTRIAL V WASTE APPROVAL a CHARGES OWNERS PERMIT $ Q 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE � r V REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE, INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19— NEW HOUSE SEWER �T/��I / /I///✓l V® OWNER OR �/7 - / CONNECT ADDITIONAL / 1 OWNERS AGENT •��- r+ BUILDING OR WORK l lr l+. I SEPTIC TANK,SEEP.PIT(S) ADDRESS AND/OR DRAINFIELD 1� ( I HEREBY ACKNOWLEDGE THAT '6 .HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ l .. I /V� l� WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR 1 PLUMBINGANDSEWERS. SEWAGE DISPOSAL SYSTEM !/ 1 lhV I I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND yI LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER Hr" rl CALIFORNIA OR THAT AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESI DEN A PROPERTY. BACKFILL SEPTIC TANKS ❑ f L SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS ❑ It %{'I OF PERMITTE r� ®r VALMATIOI�,- ROBERT A. WOOD CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER L .,6 5 4 5e ?hP r g D Jr .0 v