HomeMy Public PortalAbout5942 ENCINITA AVE_Sewer__ SaE891,-EE APPLICATION FOR PERMIT
DMSION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer -, .. . 11'.11..- ,..
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
m CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL INmoss sr.
LEGAL OWNER
DESCRIPTION LOT N0.
MAIL
BLOCK TRACT - Ap0RE5
N0. OF BLOCS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DI O �/GROUP _ _M
y� �1AP '/•,\
CONTRACTOR �1 1�{•�iA� Ilu �' To P✓ _M`7 •Yt X PG W
CONNECTION DATA (}'
ADDRESS �� ��
STATION DEPTH
CIT f]EL. NO.
MANHOLE REFERENCE UPPER
❑ STATE LOWER
REGIS'[eATION NO. /� D Y Y Cl COUNTY
No. DESCRIPTION SOF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L.TO P.L.
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD t@ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD P. C. NO.
EXTN.,CESSPOOL.DR YWELL.M AN HOLE Q $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM I $I. WASTE APPROVAL
CHARGES
CONNECTION CHARGE_FEE
OWNER'S PERMIT
_
MBURSEMENT FEE
AUTHORIZATION TOTAL FEE REI
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'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 L!!'�b �• 7
OWNERS AGENT SEPTICTANK.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 IA 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 TH EGAL OWNER OF THE ABOVE '
' DESCRIBED EN PROPER SEEP.BACKFILL SEPTIC
CTANKS❑LS❑
SIGNATU
OF PE M E
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATIOI`�.� ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
CN.
m0.
CASN
fAr'fl2 7 9 1NN MV27 4 2.00 m
576.1320
8 E46911.53 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer I -- - - -
County of Los Angeles 'I
JOHN /r
JOHN A. LAMBIE. COUNTY ENGINEER
® CASSATT O. GRIFFIN. SVP•T OF BOJ LD i NG _ LOCALITY
FOR APPLICANT TO/FILL IN CROSSS ST.
LEGAL 2
DESCRIPTION LOT NO. J yr �// OWNER
MAIL
BLOCK TRACT � / ADDRESS
N0. OF BLDGS. Il CITY TEL. N0.
SIZE OF LOT NOW ON LOT L
USE OF
. BUILDINGS - DISTRICT NO., GROUP MAP
BK PG
'
CONTRACTOR ✓ � N ��.� ,
ADDRESS /� CONNECTION DATA
• STATION ) DEPTH
CIT TEL. NO. y
MANHOLE REFERENCE /� UPPER I
,( ❑ STATE 9Z/j..
. REGISTR ON NO. � ' // ❑ COUNTY
No. DESCRIPTION F WORK FEE
TYPE OFC CTION LENGTH FROM
1 HOUSE SEWER Ly �^ J
PUBLIC SEWERCONNECTING TO $3.50 `D Y, ORB P.L. M.L. TO P.L. [J
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR GRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD �',s/ P. C. N0.
EXTN..CESSPOOL,DRYWELL,MANHOLE n $ 2.00 CO. IMP. N0. y JOB NO.HOUSE SEER
PRIVATE DISPOSAL SYSTEMG TO ® S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.�L, �)
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT _
WORK TO HOUSE SEWER @ IS 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM C $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT S 1 00
REIMBURSEMENT FEE L
AUTHORIZATION TOTAL FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER -2 t /-
SIGNED THIS DAY OF 19_ + CONNECT ADDITIONAL
OWNER OR _ `�/,fes BUILDING OR WORK
OWNERS AGENT. e • SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY KNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE AT 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED A5 REQUIRED BY L05 ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER '
CALIFORNIA OR THA I AAI THE LEGAL OW OF THE ABOVE `
DESCRIBED RESIDEN AL PROPERTY. BACKFILL SEPTIC TANKSE] �.y //
SIGNATURE SEEP.PIT(S) [I CESSPOOLS 66 /�
OF PERMITTE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
cK. M. 0. CASH
L&o 2 7 0 1 N Nov 2 6 4 4.5 0 111)