HomeMy Public PortalAbout5920 1/2 ENCINITA AVE_Sewer__ DEPAKTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 8
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT FILL IN LOCALIT
BUILDINGNEAREST
ADO RESS CROSS ST.
LOCALITY DISTRICT NO. SERIAL N0. PERMIT NO.
NEAREST
S A I�c�t08 s
CROSS 5 _ ECEIVED BV Ready for Inspection DATE ISSUED
OWNE '1— J
MAIL USEZO OCCUPANCY MAP
AODRES _' BK PG
CIT TEL-NO.
CONTRACTOR
CO.IMP. N0. Y
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ADDRESS b, JOB NO.
CITY II TRUNK PERMIT NO.
STATE
REGISTRATION/ ��1���� /® COUNTY ROAD PERMIT NO.LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT •�•
/ ` PERMIT NO.
BLOCK TRACT-o' b✓�/ INDUSTRIAL
WASTE APPROVAL
NO.OF BLDG .
SIZE OF LOT S'aX�Ov 1 NOW ON LOTS CHARGES
USE OF T
BUILDINGS Ute_ .0 sr L,� CONNECTION E FEE
NO. DESCRIPTION Eri WOR FEE
REIMBURSEMENT FEE75
HOUSE SEWER CONNECTING TOte�r-\\
PU BLIG SEWER aS 3.50 _Jv RECEIPT NO. GATE BY ' '
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER - 1.00 N0.
ALTER OR REPAIR EXISTING I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTE M 1.00 I CONNECTION DATA -
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 STATIONDEPTH �I
CESSPOOL—DRYWELL nh
SPECIAL CONDITIONS ONLY 2.00 I 11�i F_ON �IHP� �_REF ERENCE
TYPE OFL- NECTfyN��ER�I LENGTH FROM /
2Y� ( P:L.7 M.L.TO P.L. �3
OWNERS PERMIT $ I Do
AUTHORIZATION TOTAL FEE c,
I HAVE THIS DATE CONTRACTED-WITH THE HEREIN NAMEDi�
CONTRACTOR TO CONNECT THE A BOVE DE CRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS----- .. AY _.. ..._— ..Ell NEW HOUSE SEWER SG )rDrk
OWNER ORgUHLNECT DINC ORWORKOWNERS AGENT _. ..... . .��[}} SEPTIC TANK,SEEP.PIT(S)
ADDRESS._rl 9.01 .... . . .e_._.... . _...._.........._I: .. . AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL
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 1 AM PROPERLY REGISTERED AND
DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY, ABANDON HOUSESAND
AND STATE OF CALIFORNIA OR THAT 1 6M-THE LEGAL WN-
EWER
ER OF THE ABOVE DESCRIBED RE TIAL PROF ERT BACKFILL SEPTIC TANKS D
� A/ SEEP.PIT(S)o CESSPOOLS
SIGNATURE ��! �_
OF PERMITTEE ... -
76AG42A 663 7/53 /