HomeMy Public PortalAbout5824 ENCINITA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
SIVISIGN OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING ryC�/1 J
ADDRESS
FOR APPLICAy�s���T TO F�LL W LOCALITY
BUILDING NEAREST
ADDRESS .CROSS ST. V
� /�o/j
LOCALITY 1 4 �f / DISTRICT NO. SERIALJ�{`0 PERMIT NO.
NEAREST ^^ T�L l T� C /� ap- Y- S
CROSS ST. j / L(iyt�pl�e `J 7L
BC EDB Ready for Inspection DATE ISSUED
OWNER a _LS
MAIL �^� USEZONE OCCUPANCY IMP
ADDRESS iyJ(� XqNCJ/✓I //./��, BK PG
CITY_ YYY`TEEL.NO. / V`I'OL/ L
I
CONTRACTOR CO.IMP.NO.
AD SS r �'
B NO.
CIT TEL.NO TRUNK PERMIT i0.
STATE
REGISTRA / N NO. �v n �/OU NT
ROAD PERMIT NO.
DESCRIPTION LOT NO. S. 5LEGL 'b- / 7S" STATE
NOENCROACHMENT
BLOCK TRACT rn S� I INDUSTRIAL
^ /] WASTE APPROVAL
SIZE OF LOT ,5-Z XA 6 7 NOW ON LOTS a CHA ES
USE OF //'J/� �
BUILDINGS UCrC¢- a CONNECTION CHARGE FE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER Q $ 3.50 RECEIPT NO. DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR XCEPTIO RECORDED
WORK TO HOUSE SEWER 1.00
TE
ALTER OR REPAIR EXISTING I I IBY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEP IC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION EPTH
CESSPOOL-DRYWELI
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERS CE
UPPER LOWER
TYP OF CONNECTION LENG FROM
OWNERS PERMIT $ I DD Y. CUR P.L,. M.L.T P.L.
AUTHORIZATION I TOTAL FEE zim
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOA DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO BLIC SEWER /
SIGNED THIS.. .._._ ._. DAY OF...._.. ....._....__....... .KA - NEW HOUSE SEWER
OWNER OR �1 'G � � CONNECT ADDITIONAL
OV/HERS A _ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS. .... _ .. _. . ............._.._......._...._:._......_..____._. AND/OR GRAINFIELD
I HEREBY ACKNO LEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E3 DRYWELL I]
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 DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THEABOVE DESCRI REBID TIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)0 CESSPOOLS[]
SIGNATURE
OFPERMITTE ... _ _ _.........._.._.._.._......_.._......_.._...
T6A642A 663 i/5
CE800 5-65 APPLICATION FOR PERMI {�
]6A fi42D LJ
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION SUILO No ��.,p.2�/ W.
JOAN' A. LAAI ISIS, Courcy E-11Deer ADDRESS �+ U T
COLEMAN lT'. JENKINS,Sulf%. o[ If uild ing
LOCq L'iTY
NEAREST f �• /(/� C
AL FOR APPLICANT TO FILL IN y/y RQ55 5T V J
DESCRIPTION LOT NO. / / OWNER 4eIt4 A/14 1-
MAIL
L
// MAIL
BLOCK TRACT /�, l / ADDRESS
NO OF CLOGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF // y,/ '
BUILDINGS r(�� a,,X� DISTRICT NO. GfRfIIP MAP PROCEs
pp a p r •I�� BK PG
CONTRACTOR 0.610/�✓ pw .0 �v9
ADDRESS �Q�}py.3 .0 /A(.04 S/-tT h/ CONNECTION DATA
'Iy^ {// ,/ /�v J�bj 7 J STATION !� / DEPTH
CITY (J �t TEL. NO. T /tom
LICE N � q LICENSE -�' Q MANHOLE REFERENC / G R
ND. _7 V/ CLA 55
N°. DESCRIPTION OF WORK FEE TYPE OF CONNE TION LE TH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER $ 5.00 }
SEPTIC IANI St 111.1 PIT OR ♦ P.C.NO. a
PITS AND/OR GRAINFIELD C $10.00 CO.IMP. NO. I UOB NO. O
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO. V
PRIVATE DISPOSAL SYSTEM C $ 3.00 w
CONNECT ADDITIONAL BLUG, OR _ l AFFI°AVIT AIV AII"- RECORD,INSTR,NO, DATE O
WORN TO HOUSE SEWER C S 3.00 /JSLMV r
'ATTEk-RTP' R ABANDON 04 USE
SEWER OR DISPOSAL SYSTEM 9 $ 3.00 W
LTEPA ECO HVIY.OR ST.WIDENING a
E%T N.,CESCESSPOOL, MANHOLE l' S 5 DO In
r STATE ENCROACHMENT z Z
I PERCOLATION TEST C $ 5.0G PEFMIT NO,
IN DUSTRIAI
WASTE APPROVAL
OWCHARGESNER S PERMIT S 2 00
AUTHORIZATION I TOTAL FEE n ON NECTION CHARGE FEE
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTORS S I.NATURE
SIGNED THIS DAYOF 19-
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
Vr BUILDINGTOR WORK
ADDRESS
SEPTIC ANK,SEE P.lITI.I
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS, CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGjSWlD7O PND/OR ALTER.REPAIR,SEWER OR
LICENSED AS REQUIRED BY L 5 ANGLES CO Y D STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THA AM E LEGAL OW R O ANO INTEND TO
RESIDE IN, THE A ED RE ENTI PROPERTY. DISCONNECT PLUG AND
ABANDON HOUSE SEWER
SIGNATURE >
OF PERMITTEE BACKFILL SEPTIC TANKS ❑
SEEP,PIT(S) ❑ CESSPOOLS ❑
OVALIDATION
CN. M.O. CASH
LACp 5 6 8 7 m Nov 4 1 0 0 8.00-
Q
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISIQN OF BUILDING AND SAFETY PERMIT APPLICATION +'
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUORILDIESSNG
AO ✓ /�6b�r•• /
FORKLDING APPLICANT TO FILL IN /� LOCALITY G' C
EAREST
[ABDDRESS 6 A CREST
OSS ST. f-L/S 7EAREST ' ( DIST�CT N0. SEfl IA /P�MIT N0. Cf DA
OSS ST. / ./1 AREC/E��IIVVEEJD,/BBY Ready I I}n6oaction D E IISSSUEDDJWNER _ w/sA
-[RECEIVED
w7 A;spe
AOORESS _ USE ZONE 0 U/ I MAPAl -AQoO
/ BK PG
CITY TEL.NO.
CONTRACTORS A
CO.IMP.N0.
ADDRESS
JOB.NO.
CITY TEL.NO. / TRUNK PERMIT NO.
p(
REGISTRATION N0. [] STATE
ROAD PERMIT NO.
LEGAL /O
DESCRIPTION �LUTN STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT (. INDUSTRIAL
WASTE APPROVAL
NO-OF
SIZE OF LOT SB Y -,7-
7 NO W/ON LOTS// CHARGES
USE OF (
BUILDINGS GJ / ( CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ® f 3.50 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OREXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 /OO
ALTER OR REPAIR EXISTING NO' I DATE I BY
'SEWER'Oft DISPOSAL SYSTEM 1100 '
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC.TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT = 1 11 00 V. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE �I OC} S
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS---------------_---DAY OF.................._..... IY.._... NEW HOUSE SEWER
OW N ER ORJ ,/ CONNECT ADDITIONAL / d
OWNERS AGENF'v..... .._ (� ._i ... 1 ..,,.._.... „ ,.._ BUILDING OR WORK
�? T J1 i SEPTIC TANK,SEEP.PIT(S)
ADDRESS...
.167I.F.S ...T.I}�{.,�JLyy,L4�-L`I l`.�'JG�y� AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APP CESSPOOL Q DRYWELL�
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGR
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. C SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
ANO/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 RESIOENTIAL PROPERTY. BACKFILL SEPTIC TANKS
' SEEP.PIT(S)Q CESSPOOLS
,
SIGNATURE I� -
OFPERMITTEE..........
._.....
_.........
76AG42D 663