HomeMy Public PortalAbout5946 ENCINITA AVE_Sewer__ '°"°:42D
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.0. APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of LOS Angeles BUILDING Q /
WM.J. FOX. COUNTY ENGINEER ADDRESS /5-0
CASBATT D.GRIFFIN, BUP'i of BUILDING LOCALITY rJ0 P
FOR APPLICCANpT TO FII L IN moss s.
' DESCRIPTIOLEGL �LOLNOu� Jp / OWNER F
BLOCK TRACT L MAIL
ADDRESS ZAIC/ /• q
6 O NO. OF NOW ON LOTS CITY TEL. NO
SIZE OF LOT i
USE OF
BUILDINGS C' DISTRICT NO. GROUP MAP
I_ BK PG
CONTRACTOR
ADDRESS S CONNECTION DATA
CITY'6v Iff TEL. N0. ..!'Z� `��� } STATION 6r(II V DEPTH
llrwn,E MANHOLE REFERENCE
REGISTRATION NO. rjl 8� ❑ COUNTY
No. DESCRIPTION OF WORK FEE —
TYPE NECTION LENGTH FROM ^�
.HOUSE SEWER CONNECTING TO Y. C`RR P.L. M.L.TO P.L.
PUBLIC SEWER <Q B 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLUG.'OR [� P. C. NO.
WORK TO HOUSE SEWER 1.00 CO. IMP. N0. J. ! Ti JOB N0.
ALTER OR REPAIR EXISTING /,�yy
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.f4n_15
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT //
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK. SEEPAGE PIT OR
PITS AND/OR DRAINFIELD .00 INDUSTRIAL
WASTE APPROVAL
'CESSPOOL- DRYWELL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S ) 1 00
AUTHORIZATION TOTAL FEE `� �� REIMBURSEMENT FEE f70A
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAM/ED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTO SSIGNATURE
TO THE PUBLIC SEWER _
SIGNED THIS
DAY OF 19� NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL )) O
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK, SEEP. PIT(S) '
ADDRESS F� AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 114VE READ fHIS APPLITION CESSPOOL DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO IMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ ,//L r-
X SEEP. PIT(S) ❑ CESSPOOLS mss' t. ��'___��/{{{✓✓✓
SIGNATURE /
OF PERMITTE
WILLIAM J.FOX.COUNTY ENGINEER VALIDATION R.A.WOOD.CHIEF PLBG.l BPECTOR
t.? .08 6 3 61; -MtIY 29 4 4.5 7, LN