HomeMy Public PortalAbout5823 ENCINITA AVE_Sewer__ nErAxrGEExT of couxTr ExGSTEEs /SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX, COUNTY ENGINEER BUILDING•
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING SP _3 G��/ "/�/—j NEAREST
ADDRESS O0 L ,✓ /°"l CROSS ST.
LOCALITY '7 . C� DISTRICT NO. SERIAL NO. PERMIT NO. c
�Ros55,
./ .5rs T/v s A s
/REECCEIEIIVVEDDBBB Ready for Inspect on TEISSUED
OWNER, yl/ ij0 U��iPS /KGKG—/ !� X / •2 /��
MAIL Q /
ADDRESS �J l�/ry��U � - US�EZ N� OCCUPANCY I—
BK PG
CITY , TEL.NO. / ��5, z
CONTRACTOR,,�f, .. CO.IMP-N0.
ADDRESS 2 Z
JOB NO.
CITY_7 TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION N0. /t 5 —71 8 COUNTY
/ ROAD PERMIT N0.
LEGAL
/;'0
DESCRIPTION LOT NO. /V, �S' 12&11 STATE ENCROACHMENT
�J PERMIT NO.
BLOCK TRACT L6.T-T INDUSTRIAL
/^ /p.r NO.BF 3LDGS. S(I F/ WASTE APPROVAL
SIZE OF LOT NOW ON LOT CHARGES
USE OF //�� jamef
BUILDINGS//�,//6"��/U,� CONNECTION CHARGE FE
NO. - DE CRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
P BLIC SEWER @ $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL WBLDG.OR EX PTID RECORDED
ORKTO N OUSE SEWE R 1.00
ALTER OR REPAIR EXISTING NO' 0 TE IBY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SVST E M 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 [Z2-;?
ION g7'f07/3 DEPTH 71 -
CESSPOOL—DRVWELL ff
SPECIAL CONDITIONS ONLY 2.00 ANHOLE REFERENCE
, ,3 UPPER LOWERVPFOF CONNECTION LENGTH FROMOWNERS PERMIT S 1 OD � M.L.TOP.L.AUTHORIZATION TOTAL FEE 7 �3 '
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGPPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER c
SIGNED THIS......-...-_ -----DAY OF�� : ='-._1_.>�.......19.J: NEW HOUSE SEWER p, J/i A •1Jj
OWNER OR //� _ CONNECT
ORWORK-.--.,-f- ......._.........•
ADDRESS...... 1--o
- �7 - SEPTIC TANK,SEEP.PIT(S)
---T....a_./...-- .._— =__:'�:�-'.:^J:_.- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL 0 DRYWELL E]
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 1 AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS I]
SIGNATURE -'_J./�Q el?-_ / SEEP.PIT(S)Ej CESSPOOLSE]
OF PERMITTEE... �jr {
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