HomeMy Public PortalAbout5807, 5807 1/4, 5807 1/2 ENCINITA AVE_Sewer__ 78AS42D APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer - - -
County- of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS C�1'
® CASSATT D.GRIFFIN. SUPT of BUILDING LOCALITY �E
FOR APPLICANT TO FILL IN CROSS'T' /
LEGAL 'tel IcE OWNER J
DESCRIPTION LOT NO. of
MAIL
BLOCK TRACT ! a !? 77 ADDR ESS
�yA
N0. OF BLOCS. CITY TEL. NO8 3v
SIZE OF LOT NOW ON LOTkz
BUELOINGS ).� DISTRICj_j4O. GRO am-/ MAP
BK
CONTRACTOR Able I"iOn Btr.
!j _
ADDRESS
Bryant
BCONNECTION DATA
225 West ryant
CITY El Monte TEL. N0. Gi 8-6565 STATION / (,J DEPTH
168 79 II STATE MANHOLE REFERENCE
T
REGISTRATION N0. � ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
TYPE OF ION LENGTH FROM ^ L
PUBLIC5 HOUSE EW ER ER CONNECTING TO @ $3.50 Q Y. CURB
P.L. M.L. TO P.L. 0 O T
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD n P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $ 2.00 CO. IMP. NO. 3 I 9- JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT N0. -�
CONNECT ADDITIONAL BLDG.ORSTATE ENCROACHMENT
WORK TO HOUSE SEWER @ $ 1.00 O ' PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE _ INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 5 1 00
AUTHORIZATION ITOTAL FEE REIMBURSEMENT FEE
I HAYS AT THIS DATE A CONTRACT WITH THE HEREIN NAMED LONG
APPROVALS DATE INSPECTOR SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SE\'JER. NEW HOUSE SEWER
SIGNED THIST DAY OF 19 CONNECT ADDITIONAL
OWNER M BUILDING OR WORK
OWNERS AGHNT 'TTTT° ....tttt SEPTICTANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL El ORYW ELL[_1AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALT ER,REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR pISCONNECT PLUG AND /
LICENSED AS REQUIRED ( LOS ANGEL COUNTY AND STATE OF AgAN00N HOUSE$FIVER /
CALIFORNIA OR THAT AM THE L L OWNER Of TME ABOVE A J
DESCRIBED RESIDENTI PROPERTY. BACKFILL SEPTIC TANKS In
1 SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS
OF PERMITT
JOHN A. LAMBIE. C NTY ENGINEER �'ifALIDATION ROBERT A. WOOD, CHIEF PLEIG. INSPECTOR
CJ W 0. CASH
LACp 4 1 6 6 AUG 2 5 1 0 A 5.5 0 :R
f� r�
0 N�T --(rte ltiu�1/y
76AS42080 APPLICATION FOR I ERMITL�,'���-iJ -yu .
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL- 1
DEPARTMENT OF COUNTY ENGINEER - -� - - -- - • - - .....
BUILDING AND SAFETY DIVISION BUILD
INGDIVISIONADDRESS A/ C A/
]Oe
HN A. LAMBIE, County Engqiner T
WILLIAM A. JENSEN, Supt o1 Building LOCALITY ! '
.,... . . NEAREST - �.
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL OWNER
BLOCK
DESCRIPTION LOT NO. e!�
BLOCK TRACT 97 7 MAIL
ADDRESS
N0.OF BLDGS.
SIZE OF LOT NOW ON LOT 'CITY TEL NO
BUILDINGS _ - DISTRICT NO. GROUP MAP PROCESS BY
BK PG
CONTRACTOR4,6
ADORESS'7Z CONNECTION
CITY TEL. 6 � STATION DEPTH
S+r STATE MANHOLE REFERENCE UPPER
REGISTRATION NO, / ❑- COUNTY LOWER
NO. DESCRIPTION OF CZ FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ S 0 TYPE OF CONNECTI N LENGTH FROM
PETS AND/OR PTIC DRAINFGIELDIT OR @ SO 0 Y. CURB P.L. M.L.TO P.L.
OVERFLOWSEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ S .00
HOVS E SEWER C ONNECTING TO P.C. O. '
PRIVATE DISPOSA L SYSTEM @SLO : 'fiCO.IMP. NO. JOB N0. M
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. - O
WORK TO HOUSE SEWER @ St. 0 d0 U
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT 4
SEWER OR DISPOSAL SY TEM @ S 0 PERMIT N0. . O
INDUSTRIAL U
WASTE APPROVAL Y
w
CHARGES y
OWNER'S PERMIT S Q DD CONNECTIONCHAR EE
N
AUTHORIZATIOTOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE I INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. irr /
SIGNED TH)S DA{.Y/lOF 19_ NEW HOUSE SEWEROWNER OR
CONECT
OWNERSAGENT • ` BUNLDINGORWORKAL
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION - -AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATINGpLTER,.REPAIR.SEWER OR t
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM'
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR n DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
CT PLUG AND
CALIFORNIA OR THAT 1 M THE LEGAL OWNER OF THE ABOVE
ER
DESCRIBED RESIDENT AL OPERTY. _ BACKFILL SEPTIUS'C TANKS ❑
SIGNATURE SEEP.PIT(S) ❑-CE
S
S
P
OO
L
S
❑ _
OF PERMIT`
®r / v'ALISUPERVISINNG MEC ANICALO ENGINEER
/ cK. M..0.a, CASH -
L' AG03 17 5r.� AUG17 1 0 D 5.00-
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