HomeMy Public PortalAbout5825 1/2 - 5829 ENCINITA AVE_Sewer__ O
Cisoe- APPLICATION FOR PERMIT �
ceoe-e-50 COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING '
JOHN A. LANffiIE, County Engine ADDRESS �
CASSATT D. GRIFFIN. Sup't of Building LOCALITY !^Y
NEAREST 741
FOR APPLICANT TO FILi.'IN CROSS ST. r
LEGAL / L
DESCRIPTION LOT 0. OWNER _ ?nll
l MAIL /
BLOCK TRACT .. ( ADDRES
N0. OF BLDGS. ♦ p J
SIZE OF LOT Q- �. NOW ON LOT CITY TEL. N0. C /
4161
USE OF 1
BUILDINGS DISTRICT NO. GROUP MAPPROCESSEO Y
BK PG
CONTRACTOR gWAliq � � jr,
` ADDRESS CONNEC DATA
CITY TEL. NO. STATION DEPTH
STATE UPPER
REGISTRATION NO. a COUNTY MANHOL EFERENCE
No. DESCRIPTION OF WORK FEE LOWER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CO TION LENGTH FROM
PITS AND/OR DRAINFIELD @ $3.00 Y. CURB L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL,DRYWELL.MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM a $1.00 CO. IMP. NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00
pLp'RB►IMRbR A BA N DON HOUSE STATE ENCROAC MENT
ISPOSAL SYSTEM ® $1.00 �7 PERMIT NO.
INDUSTRIAL
Y WASTE APP VAL - -
CHARGES
OVtTNEWq I PERMIT $. 2 00 CONNECTI CHARGE FEE
AUTHOR=TIONFToTAL FEE 3 O-O REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. " APPROVAL$ DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF )g_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC SEP.
ADDRESS AND/ORTDRAINFEELD PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL El
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I 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 1 AM THE LEGAL OWNER OF THE ABOVE p-/ Q
DESCRIBED RESIDENTIAL PROPERTY. SEEP.BACKFPIT(S)ILL PCC CESSPOOTANKS OLB O ! ( i
? SIGNATURE ` L�
OF PERMITTE Z,
®. VALIDATJON--) . ROBERT A.WOOD
Oa. M.o. ( O�ALM SUPERVISING MECHANICAL ENGINEER
I : ,04 8 0n AL 30 -t 0 A 3 .00