HomeMy Public PortalAbout5817 - 5817 1/2 ENCINITA AVE_Sewer__ 99 E-663 I t-55 I APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Englaeer
County of Los Angeles BUDREILDING��I 7_ / 7 Z/J'aC[72c.Fi�^
JOHN A. LAMBI E. COUNTY ENGINEER ADSS
m CASSATT D.GRIFFIN, SUPT of BUILDING LOCALITY 1 4fp•._-. L�
FOR APPLICANT TO FILL IN CROSS ST. cY�J ct vy2k�
LEGAL Cl' 0 ,y -•��
DESCRIPTION LOT N0. OWNER �7- [�• r Y`JPi�2�(r�JA<'J"J
MAIL
'• BLOCK TRACT .SUk/✓`t V I-P W '.f 1^Ac �, AODR E55 7IJ
SIZE OF LOT NOWOON LOTS TEL.
USE OF .I _-. -. .. . ..-.. .... . .,,
BUILDINGS DISTRICT NO. GROUP MAP
/ P
CONTRACTOR -/� .1
ADDRESS CONNECTION DATA
4 �- Ff X f 9 I/O MAAN HO LE TION REFERENCE D PTH
TEL. N0.
CITY 67
J/ ¢STATE LOWER
REGISTRATION NO. L G ^� 7 ❑ COUNTY
NO. DESCRIPTION OF WORK FEE _
HOUSE SEWER CONNECTING TO TYPE OF ION LENGTH FROM �$'
PUBLIC SEWER @ 53.50 Y. OF
f P.L. M.L,TP.L. p(�Q
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00 _
OVERFLOW SEEPAGE PIT. DRAINFIELD P. C. N0.
E%TN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ 51.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE 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 S Oo
AUTHORIZATION TOTAL FEE 3 REIMBURSEMENT FEE
I HAVE AT THIS OATS A CONTRACT WITH THE HEREIN G DWELLING APPROVALS DATE INSPECTOR'S
`.I'
TRACTOR UB CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER {•J
SIGNED THIS/ DAY OF p 19 CONNECT ADDITIONAL
OWNER OR. ( ,� d `/iT \ �� J BUILDING OR WORK
OWNERS gGENr V 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. SEWA GE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY S ANGELES C UNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA 'OR THAT 1 THE LEGAL W IER OF THE ABOVE
DESCRIBED RESIDENTIAL OPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE. COU Y ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CN. N.0-63
. CASH
(ACD 6 3 1 7,� NOV 3 g tD A 3.0 0