HomeMy Public PortalAbout5943 ENCINITA AVE_Sewer__ DEPARTACENT OF COUNTY ENGINEM - SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES ^
WILLIAM J. FOX, COUNTY ENGINEER I DUI LDING G N ✓/-
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY �GMPLS C/T>'
BUILDING ,� 1 NEAREST
ADDRESS ��'9�G/JC%/J/7// ✓P - CRO63 ST. 11 /yI A r
LOCALITY'�^P DISTRICT N0. Ready for Insasetlon PERMIT NO.
NEARE6T..�0✓ Tomas T Jr `'`'/I// s
CROSS ST
RECEIVED BY A DATE ISSUED BY DATE
OWNER '+�fJL`�� L.T%'/ //�/I
MAIL (/1tf+'wFVf9(',
USE ZONE OCCUPANCY BK MAP PG
ADDRESS
CITY G TEL.MO. �Ye /flif
CO NTRACTO � �/� �/ ry
CO.IMP.N0. 9
ADDRESS.' i %/C!, JOB.NO.
CITr�jy)� /J QTEI.NO. C�.,L/A_ _ TRUNK PERMIT NO. /
I Tj�J O� LJ C NTY ROAD PERMIT N0. 9 ?6 DDx
ATE
REGISTRATION NO.
LEGAL ���^ STATE ENCROACHMENT
DESCRIPTION LOT N0. �/ PERMIT NO.
BLOCK TRACTINDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF SLOGS.
NOW ON LOT CHARGES
USE OF i�J�f�`/��CC�
BUILDINGS /l CONNECTI XARGE FEE
N0. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO �y _ REIMBURSEMENT FE
PU B LIC SEWER @? F 3.50 `7 6 RECEIPT NO. E IBY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00 __
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 . CJO
ALTER OR REPAIR EXISTING _L N0. I DATE IBV
_ SEWER OR DISPOSAL SYSTEM 1.00 __
DISCONNECT AND ABANDON SEWER
_ AND/011 DISPOSAL SYSTEM 1.00 CONNECTION DATA
SPTIC TANK,SEEPAGE P
PETS AND/OR GRA NFIELDIT OR 2.00 STATION 3-)1-- ,s/ DEPTH
a
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 /�os0 (� MANHOLE REFERENCE
J UPPER Lowsw
TYPE OF CONNECTION LENGTH FROM qO a
OWNERS PERMIT • $ 1, GD A, CURB ow. M.L.TO P.L. O(
AUTHORIZATION TOTAL FEE fJ p
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS. � -::::DAY F '
7• CONNECT ADDITIONAL
OWNER 0 J BUILDING OR WORK
OWNERS A ._,JL1•. � _ 'rr -.__..._
^� SEPTIC TANK. IT(S)
-
ADDRESS- �/�llY1� .. 1PCICI�.............. AND/OR DRAINFIELDFIELO
CAITHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL[] DRYWELL 0
ION 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
' HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AN LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I A LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE D�B�flI BE lA PROP TY. BACKFILL SEPTIC TANKS / A ,{I'
/ ' ; SEEP.PIT(S)Q CESSPOOLS , 'tN.I'�I�B/A _ZrsY
SIGNATURE 1
OF PERMITTEE.__ x
76AG42D S&E 663 4/54