HomeMy Public PortalAbout5713 ENCINITA AVE_Sewer__ C
24650 INSPI5�
03 6.60 APPLICATION FOR PER T
TeAczD COUNTY OF LOS ANGELES
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER.
BUILDING AND SAFETY DMSION BUILDING 3 —N�/ /
ADORES$
IGfiN A. LAMBIE, County Engqin°°r ,
WILLIAM A, JENSEN, SuP•1 of Building LOCALITY C�
NEAREST
FOR APPLICANT TO FILL INCROSS ST.
LEGAL ry 'i /O OWNER J L
OESCRIAL L N ./ A S ,r
BLOCK �J TRACT S�f N 1 glv ADDRESS
SIZE OF LOT / JS� NOW ON LOTS CITY TEL N0. d'>�
USE OF / DISTRICT N0. GROUP MAP P OCESSE
BUILDINGS BK PG
CONTRACTOR L
ADDRESS sr CONNECTION DATA
CITY �J /TEL.NOG�� La G e,21- STATION 3 DEPTH
STATE .
REGISTRATION NO. / 7 L> / 7_B COUNTY MANHOLE REFERENCE ,
LOWS
rvO. DESCRIPTION OF ORK ' FEE
/ HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 o-fl TYPE OF ECTI ON LENGTH FROM /
PETS AND/OR DRAINFPTIC TANK. GELDDE PIT
OR @ $3.00 Y. CUR P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.CO. IMP. N0. JOB NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 w
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. 0
WORK TO HOUSE SEWER @ S1.00
ALTER REPAIR
OR DIISPOSAL SY ST E M HOUSE @ $100 STATE ENCROACHMENT G
PERMIT NO. M
INDUSTRIAL V
WASTE APPROVAL a
CHARGES b
OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTCR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTAR•S SIGNATURE
TO THE PUBLIC SEWER. /f
SIGNED THIS- DAY OF— 19— NEW HOUSE SEWER A,/A 7/
OWNER OR �/1 N. i-l/ CONNECT AD$EWE AL _ ^ dAi ....,.�.r
OWNERS AGENT A- T E BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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 •f
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 1 AM THE LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS
DESCRIBED RESIDENTI L ROPERTY.
SIGNATURE SEEP. PIT(S) CICESSPOOLS CIOF PER MITTE
®r VALIDATION ROBERT A. WOOD
°K. M.o, usx SUPERVISING MECHANICAL ENGINEER
u'Aj;o 5 1 1 5 AN 10 1 0 D 5 .0 0 R