HomeMy Public PortalAbout5926 ENCINITA AVE_Sewer__ .
6&Z•a6s s.as APPLICATION FOR PERMIT 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
Department of County Engineer
County of Loa Angeles ADDRESSG t'4
WM.'J. FOX. COUNTY ENGINEER Y
ICASSATT 0. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPL^IJCAN/Tp�TO FnII L IN ceosRs sT.LEGAL
DESCRIPTION LOT,,. 3 / I --;-- OWNER r
BLOCK TRACT6S MAIL ( ^� ���� ; X
ADDRESS J k7 A IV.{(�1A
SIZE OF LOT D/� NOW ON LOTS CITY TEL. N0. / 1 41
USE OF
BUILDINGS OI DISTRICT NO. U GROUP MAP
BK P
CONTRACTOR
AooRESS4: T ,t�,.�.�J.' CONNEECTTION DATA
CITY / TEL. NO��r, t: STATION �`� i S DEPTH
!� O COUNTY TTMANHOLE R[[[EFERENCE �� A IV
LOQ
NO. DESCRIPTION OF WORK FEE
REGISTRATION N0. O
HOUSE SEWER CONNECTING TO ryy A YPE OF CONNECTIDN� LENGTH FROM A
PUBLIC SEWER Q S 3.50 `1 (J �� �� / P'L' ) LI.L. TO P.L. Q
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR P. C. N0.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. [i JOB NO. y
ALTER OR REPAIR EXISTING J�
_ SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT N0. ROAD FRI2IYI 0.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK„ SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 W APINOop
PROVAL
CESSPOOL.DRYWELL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
OWNERS PERMIT 5
CONNECTION CHARGE FEE
i 00
AUTHORIZATION TOTAL FEE S� REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNA liRE
TO THE PUBLIC SEWER r / _ /
SIGNED THIS�_SLDAY OF J �'�^^�`'ut`19 ,' NEW HOUSE SEWER �z r
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT I r' ./� ��{A� BUILDING OR WORK
ADDRESS `�7 ^ t �n�Jna1 'r'^ AND/ORSEPTIC T DRAINFEELDPIT(S)
r
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ ORYWELL❑
ANO STATE THAT THE ABOVE ICORRECT AND AGREE COMPLY
WITH ALL COUNTY ORDINANCES
S AND STATE LAWS REGULATING SLYER, REPAIR, ER OR
PLUMBING AND SEWERS. SEWAGE DISPOSALLSYSTEM
1 HEREBY CERTIFY THAT I AIA PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY-ANO STATE OF ABANDON
NE HOUSE AND
CALIFORNIA OR THAT I AM THE LEGAL�OWNER OF THE ABOVE � ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. �� BACKFILL SEPTIC TANKS❑
Jam/ 1 s i �, ` SEEP. PIT(5) ❑ CESSPOOLS ��I
OF PERMITTEE
SIGNATURE ,>✓/
., � _-
WILLIAM J. FOX,COUNTY ENGINEER_ J VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
UT60'2- -a-,_Dm 12 a 4.5.0
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