HomeMy Public PortalAbout5932 ENCINITA AVE_Sewer__ ]61:..6 •
3 APPLICATION FOR PERMIT
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S&E�683.35 ry.-
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL �a
Department o¢ County Engineer
County of Los Angeles BUILDING sy3z � �-�/G�N�T� fT.
WM.J. FOX. COUNTY ENGINEER ADDRESS /
® CASSATT D. GRIFFIN, BUP'i of BulLalNa LOCALITY 4'/�^.CJl�P
FOR APPLICANT TO FILL IN CROSS ST. F /� J
DESCR14
LEGIPTION LOT NO.3 6 O OWNER W11-1&
BLOCK TRACT S� /-�O,S(y. ADDRESS .f Ifs✓+ ��
SIZE OF LOT t] O X Ik(7 NOW ON LOT J CITY ��f EL. NO,iy T<p P�U
USE OF,
.11
BUILDINGS /�k f/.J �=NGS DISTRICT N0. GROUP MAP
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CONTRACTOR
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ADDRESS vpG /C ^AA.?.AA/y.�� CONNECTION DATA
CITY �, P�Igy!i f� T�L.yN O!� STATION ,5� DEPTH 'X
✓ y��_� a 4 ❑
STATE MANHOLE REFERENCE .r Y Lm�
REGISTRATION NO. ny 'fT /// ❑ COUNTY f L LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION- LENGTH FROM r
PUBLIC SEWER @ S 3.501 Q Y. CURE P. M.L. TO P.L.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00ADDITIONAL / / /J
C.
WORKECT TO HOUSE SEWER LDG. OR 1.00 CO.1111. NO. / / }' JOB NO.
ALTER OR REPAIR EXISTING F
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO, ROAD PERMIT NO.
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 INDUSTRIAL A
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT 5 1 00
AUTHORIZATION TOTAL FEE 41 d REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DAIE 4NSPEC 'S 5IGNAT FE
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS )L AY OF N0 V IgS d R
OWNER OR ---I/?� � CONNECT ADDITIONAL
OWNERS AGE ^ BUILDING WORK
3 > Eiv Giivi rh J T SEPTIC TANK.SEEP, PIT(5)
ADDRESS f1q N AND/OR NK I
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL C1AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR
LICENSED AS. REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER,
j
DESCRIBED RESIDENTIAL PROPERTY. , �'A BACKFILL SEPTIC TANKS❑ y�
SEEP. IT
❑ CESSPOOLS
SIGNATURE
OF PERMITTEE - -
WILLIAM J. FOX. COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
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