HomeMy Public PortalAbout5822 ENCINITA AVE_Sewer__ DEYAR1mENT OF COUNIrY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY �}��q 1?ERMIT APPLICATION
COUNTY OF LOS ANGELES �� y�!
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WILLIAM . COUNTY ENGINEER UILDIX
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FOR APPLICANT TO FILL IN LOCALITY
BUILDING rl� / '�/e/ll//Ti¢ CREAREST
OSS ST.
ADDRESS L �5 O
LOCALITY / �� DISTRICT MO. SERIAL k0. PERMIT NO.
O
NEAREST ^^ � J // `y, C J
CROSSST.
RECEIUP BY, Ready for Impaction D TE 188 ED
S .5 y
MAIL USEZ OCCUPANCY AAP
ADDRESS _ /�/� BN PG
CITU � TEL.NO. / � _2- / \ E'S �
9
CONTRACTOR w.r 4 CO.IMP. NO. /� r
ADDRESS j
IDB NO.
CITY .17C TT//EE�L.NO.4���'(' �. TRUNK PERMIT NO.
STATE
REGISTRATION NO. Q��/F '[] COUNTY
ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT
DESCRIPTI i Tl NO.
PERMIT N0.
BLOCK TRACT 5 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTN0.OF BLDGS.
/��® NOW ON LOT C RG ES
OF
SU IELDINGS11MMW2' GtJELL/NG .S'r CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEW ER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER S 3.50 RECEIPT NO. DA I BY
HOUSE SEWER CONNECTING TO
PR VATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BL00.OR ` EXCEPTIP4 RECORD
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00 _
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1-00 ONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION 9 �J y DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER TOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT S 1 00 Y'—j� y-PL. .L.TQP..L.
'AUTHORIZATIONI TOTAL FEE !Ina
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 SEWERQ
SIGNED THIS,--.,p........DA OF... ----_._.__.--19. NEW HOUSE SEWER
OWNER OR ���/a Qn�j�a� _ BUILDING NG OR WORKNECT
OWNERS AGEN ... . .. SEPTIC
ADDRESS-----------------------_.._..-...._....__ - ... AND/OR GRAINFIELD
HERS
PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL
CATION AND 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
ABANDON HOUSESAND
AND STATE OF CALIFORNIA OR THAT I AM,.THE LEGAL OWN-
EWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROP,ERTY. ; BACKFILL SEPT CESSPOS
SIG NATUflE < �}/�{��tJ///L}/V/1/..Vl!/!/�//f / SEEP.PIT(S)ECESSPOOLS
OF PERMITTE - / rA/--
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