HomeMy Public PortalAbout5828, 5828 1/2 ENCINITA AVE_Sewer__ E-663 11-55
APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING3
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS-7
® CASSATT D. GRIFFIN, SUPT°F BUILo1Nc LOCALITY 1 MNO.FOR APPL,I/CANTT�iTO FILL/IN y CROSS ST.
LEGDESCRIPTION LOT NO. /y— }jJ, /Al _ / y OWNER MA L
BLOCK TRACT /_�a ADDRESSGyNO. OF BLDGS. CITY
SIZE OF LOT-%' '� NOW ON LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS S�
y BK PG
CONTRACTOR 9
ADDRESS T(i" CONNECTION DATA
"- j6'STATIMANHON REFER ICE DEPTH UPPER
CITY TEL. 0.
❑ STATE LOWER
REGISTRATION N0. / ❑ COUNTY ^,
No. DESCRIPTION OF WORK FEE yff
HOUSE SEWER CONNECTING TO TYPE OF NNECTION LENGTH F M
PUBLIC SEWER @ S 3.50 Y. RB P.L. M.L. TO
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00 —
OVERFLOW SEEPAGE PIT. DRAINFIELD C.CO. IMP. NO. No.
EXTN.,CESSPOOL,DRYWELL,M AN HOLE @ $ 2.00 JOB
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM r@1 S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROAC NT
WORK TO HOUSE SEWER @ S 1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRI
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE fflW.ROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT g 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE I NSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19_ CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK �3
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I 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 I AM THE LEGAL OWNE OF E ABOVE —
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE rwlte
JOHN A. LAMBIE. COUNTY ENGINEERVALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
0C�' M.0. CASH
Lr 121 7 4 3.00