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HomeMy Public PortalAbout5739 ENCINITA AVE_Sewer__ t APPLfCATION _F'OFR PERMIT B e E-663 e DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Deportment of County Engineer - County of LOB Angeles eUILOING 5 3 C!'�1�• V WM. J. FOX, COUNTY:ENGINEER ADOR EBG CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER BLOCK TRACT g1(�y yj V ' `W MAIL �_ y ADDRESS SIZE OF LOT KOW ON LOTS CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP ' BK PG CONTRACTOR ADDRESSt/ CONNECTION DATA CITY TEL. N _ 5%71 STATi N DEPTH STATE MANHOLE REFERENCE REGISTRATION NO. �J d COUNTY UPPER LOWER TYPE 0 ONNECT ION LENGTH N NO. DESCRIPTION OF WORK FEE Y. CUR P.L. M.L. L. HOUSE SEWER CONNECTING TO PUBLIC SEWER n $ 3.50 _ HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 _ CONNECT_ADDITIONAL BLDG. OR ,r- CO. IMP. NO. NO. WORK TO HOUSE SEWER 1.00 _t ALTER OR REPAIR EXISTING' SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD Pc IT NO. DISCONNECT AND ABANDON SEWER STATE ENCROA HENT _ AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR _ PITS AND/OR DRAINFIELD 2.00INDUST RI CESSPOOL- DRYWELL WASTE PROVAL SPECIAL CONDITIONS ONLY 2.00 / CHARGES CONNECTION CHARGE FEE OWNERS PERMIT 5 t 00 AUTHORIZATION TOTAL FEE _ REIMBURSEMENT FEE TRACTORHAVE T TO CONNECT THE DATE ABOVE DTNCRITHE B EDEX EREISTINGAMED DWELL NG APPROVALS GATE INSPECTOR'S SIGNATURE TO THE PUBLIC SSEWEE SIGNED THIS—"UO S• 19 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL 1 1lI OWNERS AGENT BUILDING OR WORK 11 SS .� OPTI l.rw..lR L.J SEPTIC TANK, SEEP. PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I 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 iE AR E DESCRIBED RESIDENTIAL P OPERT BACKFILL SEPTiC TANKS❑ SEEP. PIT(S) ❑ CESSPOOLS❑ SIGNATURE OF P E WILLIAM J. F OUNTY ENGINEER VALIDATION BY _W; O 6 51S APR 26 4 2.00 ID BY DEPUTY DEPUTY � { L— B7 By ® DEPUTY DEPUTY seCE-6311-53 APPLICATION FOR PERMIT DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County Engineer - - - - --• County of Los Angeles EU ESVG. .C^ y 2 p• ' JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS J LTJ ® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY _ ' FOR A PL CANT TO FILL IN CEOss"E ST. LEGAL /_O OWNER DESCRIPTION LOT N P _ MAIL BLOCK TRACT ADDRESS V NO. 01 BLDGS. CITY TEL. NO. " SIZE OF LOT l u / 10 NOW ON LOT f�� USE OF BUILDINGS �: DISTRICT NO. GROUP MAP L BK PG CONTRACTOR Jr � CONNECTION DATA ADDRESS r STATION DEPTH T TEL. N0. - MANHOLE REFERENCE ❑ STATE 'LOWER REGISTR ION NO. ❑ COUNTY - - NO. ,DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TOTYPE LENGTH FROM Y. ,,CU�RB JJ P.L. M.L. TO P.L. _ PUBLIC SEWER @ $3.50 SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR'DRAINFIELD 9 $3.00 OVERFLOW SEEPAGE PIT;DRAIN HOLE CO. IMP. NO. IOB N0. lVI JJ r OVERFLOW SEEPAGE YWELDRAIMAN FELE @ 3 2.00 HOUSE SEWER CONNECTING TO { PRIVATE DISPOSAL SYSTEM n $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG. OR STATE ENCROACHMENT WORK TO HOUSE SEWER O $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL 1 SEWER OR DISPOSAL SYSTEM' © $1.00 WASTE.APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT S I Da REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE L I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED coN. APPROVALS DATE INSPECTOR'SSIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING p � ! / TO THE PUBLIC SEW E O _ NEW HOUSE SEWER SIGNED THIS DAY/ 1JANDIOR CONNECT ADDITIONAL OWNER. OR /J l ` BUILDING OR WORK - OWNERS AGENT / \\\ SEPTIC TANK,SEEP. PIT($) ADDRESS AND/OR DRAINFIELD HEREBY ACKNOWLEDGE T AT I HAVE READ THIS APPLICESSPOOL❑ ORYWELL❑AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO WITH ALL COUNTY ORDINANCES AND STATE LAWS REGUALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED CONNECT PLUG ANO LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STABANDON HOUSE SEWER CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ 6�A/. " SIGNATURE SEEP.PIT(S) ElCESSPOOLS OF PERMITTE A JOHN A. LAMB E. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR C8. H.0. C�SH lj,ro1 6 4 9 z24 4 . 4_.50 m