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HomeMy Public PortalAbout5830 ENCINITA AVE_Sewer__ AD s& _. APPLICATION FOR. PERMIT 5 S O42 11-Le DIVISION'OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL Department of County-Engineer .. _ . ., _.. County of Los Angeles BUILDING ; d JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS ® CASSATT'D. GRIFFIN. SUPTOFBUILDING LOCALITY _ FOR APPLICANT O FILL IN IRAsR sr: Hew LEGAL f" • '� OWNER DESCRIPTION LOT NO. r f MAIL BLOCK TRACT / ADDRESS NO. F BLDGS. ' SIZE OF LOT NOW ON LOT CITY TEL. NO. . USE OF DI BUILDINGS STRICT N0. GROUP MAP ' CONTRALTO � s r L �G CONNECTION DATA ADDRESS ?A STATION - DEPTH CITY TEL. NO u MANHOLE, _ UPPER LOWER REGISTRATION NO. COUNTY NO. DESCRIPTION OP'N R///-----/// FEE HOUSE SEWER.[ONNECTING TO TYPE OF CONNECTIONf LENGTH F k PUBLIC SEWER @ S 3.50 Y. CURB M.I. TO P�. SEPTIC TANK,SEEPAGE PIT OR y PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT, DRAINFIELDP. - N0. EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00 CO. IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM © S 1.00 TRUNK PERMIT NO. ROAD PERMIT CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER (rye S 1.00 Qf7 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL SEWER OR DISPOSAL SYSTEM @I S.1.00 WASTE APPROVAL ' CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT g 1 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N-MED con- APPROVALS DATE INSPECTOR'SSIGNATURE 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 OWNERS AGENT SEPTIC TANK,SEEP,PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL O DRYWELL O 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 I AM PROPS LY REGISTER O AND/OR DISCONNECT PWG AND LICENSED AS REQUIRED BY LOS NGE . COUNT A /STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT M1I A OW 0 HE ABOVE DESCRIBED RESIDE PR P .1 BACKFILL (SEPTI CESSPOPTIC TANKSOLS ElSIGNATURE SEEP. PIT OF PERMITTEE , JOHN A. LAMBIE:COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR CK. Y.O. ASN i 0' 8'9 5 AUG 7`