HomeMy Public PortalAbout5756 ENCINITA AVE_Sewer__ DEFARTnffivT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX, COUNTY ENGINEER I AUILDING
DDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING rry / ,/ r NEAREST ^I
ADDRESS �.7 j✓�' 6 //. L/k1l/,Y�QJ CROSS ST. / V //A
LOCALITY DISTRICT N0. / SERIAL N0. PERMIT N0.
NEAREST 1JTT K q�P� i3Q S
CROSS ST. .11111.11."e Q�jU /
RECEIVED
C Ready far Inspeetiond— DATEISSUED
S3
OWNER
MAIL
P
ADDRESS .,s�3'7/y1/1/, �i7Ni//i�CJJ USE ZONE I OCCUPAN BKMP.G-
CITY TEL.NO. 7 .
CONTRACTOR �
�� �Q 9 )�
CO.IMP.ND. SD
ADDRESS ✓�. 0,/.tai. ?rye JOB.NO.
CITY � � fy TT,EL.NO.
TRUNK PERMIT NO.
�§ /
REGISTRATION NO. , �1j.3/>O ❑ COTU NTLEGL AVY y� •I •� h C G/
ROAD PERMIT N0,
DESCRIPTION LOT NDJ�00• 40 �f� STATE ENCROACHMENT /
PERMIT NO.
BLOCK TRACT 6s6� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT ✓��' / N0,OF BLDGS. �I
tNOW ON LOT L CHARGES
USE DI G ,� CONNECTION CHARGE FEE
USE 0FNGS ,moi filaScJ, y!✓�C�O/ //��
--- -NOc -DESCRIPTION-OF-WORK FEE - REIMBURSEMENT FEE -
HOUSE SEWER CONNECTING TO ��,ll
PUBLIC SEWER @ S 3.50 ` V RECEIPT NO. -^AiE�—I'BY-
� HOUSESEWERCONNECTINGTO -
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING E IBY�
SEWER OR DISPOSALEXISTIEM 1.00
DISCONNECT AND ABANDON SEWER '
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATASEPTIC TANK.SEEPAE
PTS AND//OR ORAINFGELDIT OR 2.00 STATION V� DEPTH b '
C
ESS POOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE A1107'
(
UEP�.Rr /I/07' LOWER
-.TYPE OF'CONNECTION LENGTH FROM -•���
_ =V— CURB •P:L: M.L:TO-P.L.'
OWNERS PERMIT ; 11 00
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE•HEREIN NAMED -
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER L
SIGNED THIS.....LJL:...DAY ..........:19-up NEW HOUSE SEWER ?_2�_ sl
OWNER OR /�/• CONNECT ADDITIONAL •/
OWNERS AGENT.-_5..�!_:- :-_ �"v _ BUILDING OR WORK
.._-._...-.--.--_--------------_-
/ SEPTIC TANK,SEEP.PIT(S)
ADDRESS.....----_.._._----------_.-..--_--_------_._--.---_..._-.----_-._-._...---_--- ARD/OR DRAINFIELD
CAITHEREBY ACKNOWLEDGE-THAT.1 HAVE READ THIS APPLI- CES SPOOL Q DRYWELL
IONAND 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 REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED By LOS ANGELES COUNTY
AHD"STATE:OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER ,
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I I
+ '' _ SEEP.PIT(S)o CESSPOOLS Qj �"��� 3:22:1�L,
SIG PERMIT f/ �. /
OF PERMITTEE--_- .:JPY-��2: _ .?�.. :!I�•�._��.....-- _ _ - - .; ..
76A642D 663 1/53