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HomeMy Public PortalAbout5705 ENCINITA AVE_Sewer__ 46S�IN� 76864°-°° APPLICATION FOR PERMIT TCA°Azo COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION anoness j15 © mowe % !- JOHN A. LAMBIE, County Engineer WILLIAM A. ]ENSEN. Supt o! Building .LOCALITY, FOR APPLICANT TO FII3L IN NEA CROSSS I T T. LEGAL % / dDESCRPTION LOT NO. OWNER7Ay.K rA G® C'V`J BLOCK TRACT / MAIL - ADDRESS �ti 0.0 LDGS IZE - SOF y LOT .# z 1D NOW ON LOT CITY TEL. NO. .._. .,_,. ,. ....i USE OF DISTRICT Ng', GROUP MAP ROCESSED BY BUILDINGS �✓ BK PG CONTRACTOR - � UY I l � I� � ADDRESS j j o/—NNECTION DATA `•'^ , /•\_I/ CITY TEL.NO. ��� STAT 1 DEPTH STATE 0 MANHOLE REFERENCE REGISTRATION NO. B COUNTY LOWER NO. I DESCMPTI OF WORK F HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROMSEPTf PITS LC TANK,AND/OR DRAENFIELDT OR @ $3.00 Y. CURB P.L.p M.L.TO P.L. I ./ OVERFLOW SEEPAGE PIT, DRAINFIELD 1CU ZB K� EXTN..CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO OO P, . PRIVATE DISPOSAL SYSTEM @ SI.00 CO. IMP. N0. �cJ JOBB NO. p. CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. CaG O WORK TO HOUSE SEWER @ $1.00 SEWER. REPAIR RO R ABANDON L SYSTEMHOUSE @ 51 00 STATE ENCROACHMENT In / tT PERMIT NO. O INDUSTRIAL WASTE APPROVAL 0. CHARGES OWNER'S PERMIT $ 0 CONNECTION CHARGE FEE AUTHORIZATION' TOTAL FEE j-r e-D REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CDN- TRACTOR' TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE _ INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. - ^ SIGNED THIS—DAY 0 9— NEW HOUSESEWEa - / I//. F n11,r�12.'�'" OWNER A 1. BUIILD NG ONECT R WORK / ' 6�- V IGvr OWNERS AGENT ADDRESS SEPTIC AND/ORT RAINFEPIT(S) ELD I HEREBY-ACKNOWLEDGE THAT I .HAVE READ THIS APPLICATION _ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ I WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT 1 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 M THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDENT L ROPERTV. BACKFILL SEPTIC TANKS ❑ SIGNATURE - .SEEP. PIT(,) ❑ CESSPOOLS.❑ _ OF PERMITTE ®F VALIDATION . ROBERT A. WOOD - CK.. m.0. usN SUPERVISING MECHANICAL ENGINEER 5 . 9 I ;i'l g = 1 D 25.00 14'65 0INSERTS CEO 08 6-60 APPLICATION FOR PERMIT T6A6A2D COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER - 11 1—. — .. -- _ _, ... . BUILDING AND SAFETY DMSION BUILDINGb�' L �'�/ A ADDRESS 4F vn' AT IUiLLA A. LA248iE, C.°aaty Engiae°r W1M A. IENSEN. t of HuSup9ding LOcq CITY �-' 11 NEAREST FOR APPLICANT TO FILL IN CROSS sr. LEGAL DESCRIP ION LOT NO.5 I��/j - L OWNEMAIL v4 BLOCK TRACT S /A it/ AD RES V .n NO.OF SLOGS. �( SIZE OF LOT Ny %� NOW ON LOT 3 CIT EL. NO. USE OF DISTRICT N0. GROUP MAP BK PG PRPCESSEO BY BUILDINGS .. �� / CONTRACTOR - (J I L I �"�i�'l0.il(I ) ADDRESS '— /_ /� CONNECTION DATA x.� ET CITY TEL.NO. L-.eGNGo S ATION /4 Q 8 DEPTH it STATE MANHOLE REFERENCE �y REGISTRATION NO. �� COUNTY �J LOWER No: DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM SEPTIC PITS AND/OR DRAINFIELDT OR @ 53.00 Y. CURB P.L. M.L.TO P.L. OVERFLOW SEEPAGE PIT. DRAINFIELD EXTN..CESSPOOL. DRYWE LL @ S2.00 HOUSE SEWER CONNECTING TO CO. I W'. N0. 3 7 Z� JOB N0. PRIVATE DISPOSAL SYSTEM 9 $1.00 WORK TOTHOUSEISEWERBLOG.OR @ SI 00 TRUNK PERMIT NO. ROAD PERMIT NO. 9 S U ' SEW ER.OE PAIR R ARANDO SYSTEM HOUSE @ $1.00 STATE ENCROACHMENT P° PERMIT N0, M INDUSTRIAL U WASTE APPROVAL W CHARGES w OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE Q V REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE.DESCRIBED EXISTING DWELLING APPROVALS 1 R' DATE q INSPECTOS SIGNATURE TO THE PUBLIC SEWER. / / �p�/ N�r _ SIGNED THIS DAY OF 19— NEW V HOUSE SEWER `i S I /-Ift� " - OWNER OR CONNECT ADDITIONAL OWNERS AGENT I_/� l BUILDING OR WORK / I V /Y ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR GRAINFIELD III/A I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL ANDSEWERRDINANCES AND STATE LAWS REGULATING a ALTER,REPAIR,SEWER OR PLUMB SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR /,tI LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF —DISCONNECT N ABANDON HOUSE SEWER LII / 1 1 A A/1 t CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDE TI l PROPERTY. BACKFILL . PIT SEPTIC TANKS) El0❑LS ❑1 III ".. I SIOF PERMETTE r ®. VAIMATIONROBERT A. WOOD IJ* CK M ow EA ) SUPERVISING MECHANICAL ENGINEER L:.o 6 5 4 ;':Y 8 1 D 5 .G-0