HomeMy Public PortalAbout5825, 5825 1/2 ENCINITA AVE_Sewer__ o�� 1
P
C'aOa APPLICATION FOR P RIVIIT
aeoe e.aP COUNTY OF LOS ANGELES2S
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION Bu1LDINc �- _ t-� /
ADDRESS d )
J037 A. LANDIIE, CounlT
CASSATT D. GRDFIN. RuDI aI euBdinp LOCALITTe
NEAREST
fo 64
FOR APPLICANT TO FII 1/ IN „A CROSS ST. r
LEGAL ! OWNER 'L l
DESCRIPTION LOT N0.
BLOCK TRACT c' ., MAIL -
/ J(,( . ' /•' 'j ) ADDRESS �)
SIZE OF LOT l G /7 NOW ON LOTS CITY aL l ` L. NO.'ALr-
USE OF
'U'
LOINGS /9 l S DISTRICT NO. GROUP MAP PROCESSED BY
C G BK PG
CONTRACTOR IMAY Ali Lose
ADDRESS J'- Q 1 CONNECTION DATA
CITYS A u II/1 ApI nAd TEL.NO.ZGL 7 5 70 STATION DEPTH
STATE MANHOLE REF REICE UPPER
REGISTRATION NO. B COUNTY LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO xk= '
PUBLIC SEWER @ $0.00 TYPE OPP C N CTIO LENGTHFROM
PETS AND/OR PTIC ORAINFIIELDIT OR @ $$.00 T. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN..CESSPOOL.DRYWE LL @
P.C.
HOUSE SEWER CONNECTING TO O.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. NO. JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. RO T N0.
WORK TO HOUSE SEWER @ $1.00
ALTER. R DISPOSAL SYSTEM HOUSE @ $1 00 STATE ENCROACHMENT
SEWERPERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNEWS PERMITS Q d/��)
CONN ION CHARGE FEE
AUTHORIZATION TOTAL FEEREIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC S WE � /q�
SIGNED THIS DAY OF ISI&D y NEW HOUSE SEWER
OWNER OR . CONNECT ADDITIONAL y/ {
OWNERS AGENT ( BUILDING OR WORK
^ SEPTIC TANK,SEEP.PIT(S)
ADDRES AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 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 HE ABOVE
DESCRIBED RESIDENTIAL PROPERT � " BACKFILL SEPTIC TANKS ❑
SIGNATURE / SEEP.PIT(S) ❑ CESSPOOLS ❑
OF PERMITTE
A.
VALIDATION ROBERT� WOOD✓� �j/ .f6-'�`^-^ OK, M.0. / Ga` "tl / SUPERVISING MECHANIC-AL ENGINEER
V ,
0 .r � :,EP ?3 .. � p �.,,
DEPARTNffiVT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
FDRDE'S
NEAREST
CROSS ST. -L1/
DISTRICT N0. SSEERIAL NO. �J/PERR MMIT NO.
V A (S �D /(OIS
L,,, RECEIV EDDBY ReaaY I.,laeaee1I.a DATEIISSSUE`D
A 'r/.G^Y Iro.� e�t� �//7 ` _Z7 J3
n USE20NE OCCUPANCY MAP
ADDRESS QP.OraLM-n C.� SK PG
CITY ,
CONTRACTOR !�1J � CO.IMP.N0. /37Z
ADDRESS /{rj �}° IG8.N0
CITY�U�7yt..�I Q� TEL.NO.(je /.3�I I, TRUNKSTATE
.or-
REGISTRATION N0. ROAD-PERMIT-140COUNTY ROAO•PERMIT- 0 2 /C70Q
LEGAL
�,/O * r� e
DESCRIPTION LOT N0. S %
' /Or NIA?O DF�� STATE ENCROACHMENT
PERMIT'NO��—+�
BLOCK TRACT U L..1 INDUSTRIAL
X�t� NO. SLOGS. 'S� WASTE'APPROV ALL
SIZE OF LOT yOXp.7T NOW ON LOT &QEOF _ CHARGES
US
eU1L01XG5 11 CONN ECTI HARGE fEE
-- NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIM BURSEMENTIF
PUBLIC SEWER 0 $ &SO RECEIPT NO. DATE I IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTi N RECOtEP
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING " ' I DATE
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER \
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR �(`e
PITS AND/OR GRAINFIELD 2.00 STATION 9T✓O 3 DEPTH S�
CESSPOOL—DRV WELL —� MA EFERENCE
_SPECIAL CONDITIONS ONLY 2.00 GTS SU� NM"&-Q
r QUPPERj
YPE OF CONNECTION LENGTH FROM�O Q
OWNERS PERMIT $ I I 00 /Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE I
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---------------------
................... 19.._... NEW xousE SEWER I 5�1_--f
OWNER OR
CONNECT ADDITIONAL
-
OWNERS AGENT-------------------_------_----------_.._----------_--------------_. BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
ADDRESS..............._......_......_.................._.........................._.........._... AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ.THIS APPLI• CESSPOOL DRYWELL
CA
TIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO GO RI PLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER. REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 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 THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS C
SIGNATURE PERMIT SEEP.PIT(S)Q CESSPOOLS
l t,/J J�
OF PERMITTEE........ ..�.....:._J�T..._.L....:._.:.L:. ......_.
76A 6421) 663 1/53