HomeMy Public PortalAbout5716 ENCINITA AVE_Sewer__ DTPARTATTO VT OF COUNTY ENGINE SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF TOS ANGI>:T.Try BUILDING / . IC //
WILLIAM J. FCX, COUNTY EN[3INECR
BUNo ��/ IY GNC/r�/J-if �7y
sF�OR APPp)CANT TO FILL IN LOCALITYUILDING
ADDRESS yJ /�3� O:J�'INEAFEST
/✓I I•/ rte CROSSST. Z/ 4/,dw, D9/�
LOCALITY NEAREST
DISTRICT NO. Ready for Inspection PERMy NO.
T _ S
NEAREST W /S�
CROSS ST. I (F (/¢ SHE C EIV EC BY DATE cISSUED BY DATE
OWNER_ �/ r�'fl L., � L-•� �P. /�„O �'"//-3 3
MAIL USE ZONE OCCUPANCY MAP
ADDRESS BK PG
CITY TELAO. �J�
CONTRACTORi4k:d,AyC IJT CO.IMP.NO. Y,-,/ 7 r :
ADDRESS '--�
CITY C' ! fj04/�� TEELMO�o � p TRU PERMIT NO.
REGISTRATION N0. 1�/ J2 t;f 93 2 / STATE\ ROAD PE IT NO.LEGAL
—DESCRIPTION LOT N0. STATE ENCRb,4cHMENT
�— PERMIT NO.
BLOCK TRACT fj INDUSTRIALPPR
OVAL
WASTE A
SIZE OF LOT yOX �ZyrfOF BLDG .
s..NOW ON LOTS CHA S
USE OF
BUILD,NGS Fa CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE --
HOUSE SEWER CONNECTING TO REIMBURSEMENT F
PUBLIC SEWER @ $ 3.50 RECEIPTNO I DATE BY .
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_ WORK TO HOUSE SEWER 1.00 _
ALTER OR REPAIR EXISTING NO- I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA /
— SEPTIC TANK;SEEPAGE PIT OR STATION Z i` /7, 9 DEPTH
PITS AND/OR GRAINFIELD 2.00 �"FFF
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MA REFERENCE
SI0 PE LOWER
TYPE OF CTION LENGTH FROM p
OWNERS PERMIT = 1 Y. URB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE In
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE/PUBLIC SEW R
SIGNED THIS—,I.—DAY OF ._19_ NEW HOUSE SEWEROWNER OR
OWNERS AGENT{-��� /L�er' BUILDING ORECT WORK
/''� � SEPTIC TANK.SEEP.PITS)
� - i
-�-�'-•-"-1 -i�- -'e'= AND/OR GRAINFIELD t
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL Q DRYWELL 0
CATION AND STATE THAT THE ABOVE IS CORRECT AND 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 AfGISTERED
AND/OR LICENSED AS REQUIRED BY LOS NG ESJCOUNTY DISCONNECT PLUB AND
AND STATE OF CALIF IA OR THAT I A TH LEGAL OWN- ABANDON HOUSE SEWER _
ER OF THE ABOVE SCRIBED RE J)EN AL ROP,ERTY. BACKFILL SEPTIC TANKS
SIGNATURE - SEEP.PIT(S)Fj CESSPOOLS rflOM..r 1IKIS FK
OF PERLNTTE ._.
76d692D R 4/54