HomeMy Public PortalAbout5702 ENCINITA AVE_Sewer__ r1466 IN 917,
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CE8066-6° APPLICATION FOR PERMIT _.
'6A6020 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER. 1-7'—
BUILDING AND SAFETY DMSION em LDING
ADDRESS
4 ILLI AL JENSENC Sup'l ofn
nBuilding
'LOCALITY /
.. . a _...._. ,... . _...._ .. .... NE0.ft EST C.
FOR APPLICANT TJ9 _IqL aN to p En sr.
LEGALO ✓rf OWNER iG-
DESCRIPTION LOT NO. /h Z. '�3,J .�L _
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO. _
USE OF DISTRICT NO. GROUP - MAP PROCESSED BY
BUILDINGS )--'�( y] I{ BK PG _
CONTRALTO �• L'
ADDRESS CONNECTION DATA
CITY/ TE((L.NO. .o' /� � STATION I DEPTHSTATE
�.
REGISTRATION NO. / dl%J T ` COUNTY - MANHOLE REFERENCE 1 LOWER
NO, DESCRIPTION OF WORK FEE1
/ HOUSE SEWER CONNECTING TO U�
PUBLIC SEWER @ $3.00 TYPE OF CTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. URB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.N0.
PRIVATE DISPOSAL SYSTEM @81.00 CO. IMP. NO. I. JOB NO. p S.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. Sd
WORK TO HOUSE SEWER @ $1.00 1 O
ALTER. REPAIR OR ABANDON HOUSE STATE ENCROACHMENT m
SEWER OR DISPOSAL SYSTEM @ $1.00 .PERMIT NO. O
N
INDUSTRIAL W
. . WASTE APPROVAL �y
— CHARGES a
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION NOTAL FEE REIMSURSEMENTFEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESC BED EXISTING DWELLING - APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. --,n,./
SIGNED THIS DAY OF 191 ! NEW HOUSE SEWER l 7 X`1L!77$!111�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ BUILDING.OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY. ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION - - -
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. - t SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/ORDISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF gBANDON HOUSE SEWER '
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDE IAL PROPE TY. l
SIGNATURE L, SEEP. PIT(S) ❑ CESSPOOLS ❑
OF PERMITTE
®P VAL ROBERT WOOD
CK. M..0.o. Gsx SUPERVISING MECHANICAL ENGINEER
1Lo 1. 0 3 8 Z v k0 13 1 0 Q 5 -00 a