HomeMy Public PortalAbout5813 - 5815 ENCINITA AVE_Sewer__ ,eAeA=a APPLICATION FOR PERMIT
BeE803 11-55
DIVISION OF BUILDING AND SAFETY SEINER—SEWAGE DISPOSAL
Department of County Engineer 1 - ' -
County of Los Angeles BDDILDESS ✓ING
. -J J //. :7✓"C�^"'�L�4/
JOHN A. LAMBIE, COUNTY ENGINEER AOR
® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY rN� cy
FOR APPLICANT TO/FILL IN y ceoss si.
LEGAL
-DESCRIPTION LOT NO. /.` Q I �J(Q /gS_d�l OWNERMAI L
J
BLOCK TRACT M g 3 _ i 5- ADDRESSNO. F / �
SiZE OF LOT ' NOWOONBLOTS CITY sLT�JN�wDf�jy(�TEL. NO ,
USE OF DISTRICT NO. GROUP MAP
BUILDINGS / BK PG
CONTRACTOR - 61cmM1 5 �+ G7
CONNECTION DATA
ADDRESS �.�yJ�"� -
IiV�fl! �•, d ([D�/ STATION 1 ® DEPTH
` CITY TEL. NO.
['7,/ ❑ COUNTY MANHOLE RE ERENCE �F a"A/ A,/ LOWER
REGISTRATION NO. I� Y.i I)L STATE �V
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF TION LENGTH FROM /
/. Y. CURB P.L. M.L. TO P.L. ZO
PUBLIC SEWER @ $3.50 d
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD A P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. i( lOB N0.
HOUSE SEWER CONNECTING TO
PRIVATE EWER CON SYSTEM @ $L00 TRUNK PERMIT NO. ROAD PERMIT N0.3n�/ ?-/
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
I ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
ARGES
CONNECTION CHARGE FEE �
OWNER'S PERNI T s o0
REIMB URSEMENT FEE
AUTHORIZATION TOTAL FEE D
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSP CTOR'S SIGN ATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SE ER. .� / NEW HOUSE SEWER 14
SIGNED THI5Z6-DAY OF t/ 19 CONNECT ADDITIONAL
OWNER OR //, BUILDING OR WORK
OWNERS AGENT_a � `� '��� � - SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. `�' /E`l BACKFILL SEPTIC TANKS❑
SIGNATURE �ti� L�.Id /`I SEEP. PIT(5) ❑ CESSPOOLS❑
OF PERMITTEE 11--11 111
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
cm.
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