HomeMy Public PortalAbout6005 ENCINITA AVE_Sewer__ ieASAza APPLICATION FOR PERMIT _
8ee8DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
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County of Lae Angeles BUILDIrvGWM.J. FOX, COUNTY ENGINEER ADDRESS •/�CA66ATTD. GRIFFIN, BUP'TofBUILDING LOCALITYFOR APPLICANT TO FILL IN caoss SLEGALDESCRIPTION LOT NO. / OWNERBLOCK TRACT / o` • MAILADDRESSNO. OF SLOGS. !�SIZE OF LOT /1 NOW ON LOT , YL CITY c�q.q; i TEL. N0.
BUELOFN GS G. .f -� �' `tea/Q q1t, DISTRICT N0. GROUP MAP
A ' BK %G
CONTRACTORS ,� .( J i/ L
ADDRESS h.1i CONNECTION DATA
CITY �i TEL. N0.A•T�% -/ � :/ STATION DEPTH /0 O
�❑ COUNTY MANHOLE REFERENCE 1 Q O �
REGISTRATION NO. �S .J LOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ( Q TYPE OF ECTION LENGTH FROM V O
PUBLIC 5-W ER Q 5 3.501 ,� _`r/— Y. RBS P.L. M.L. TO P.L. d G
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR 'J P, C. N0.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. JOB NO. p
ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.3J/}y 1/s
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
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S 1 00
AUTHORIZATIONTOTAE FEE LL (� REIMBURSEMENT FEE
1 HAVETHIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURC
TO THE PUBLIC SEWER
SIGNED THISNEW HOUSE SEWER
_—DAY OF 19—
OWNER OR ; ,,`` CONNECT ADDITIONAL
OWNERS AGENT ( �1�tAL'I V 'Y/l BUILDING OR WORK
SEPTIC SEEP.
ADDRESS AND/ORT DRAINFIELDPIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[IDRYV.'ELL❑
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
1 HEREBY CERTIFY THAT I AM PROPERLY REGIS EKED AND/OR
LICENSED AS REOUIRED BY LOS ANGELES COUNT AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEG OWN OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PERT BACKFILL.BACKFILL SEPTIC TANKS C Ln I
SIGNATURE ,'f,^, SEEP. PIT(S) ❑ CESSPOOLS]!1 e Z�' �/U I'G
OF PERMITTEE r�L' "r 1 O
WILLIAM J.FOX.CWWY ENGINEER ATION R. A.WOOD, CHIEF PLBG. INSPECTOR
M4660�9 APR 2 4 4.50
,
CEBOB - APPLICATION FOR PERMI
>BA ea2D,z2,
COUNTY OF LOS ANGELES SEWER—SEWAGE ISPOSAL
`DEPARTMENT'OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADORES.
COLEMAN W. JENKINS. SUPT. OF BUILDING J G
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN `ROBS BT. ret
LEGAL
DESCRIPTION LOT NO. OWNER /l--jeQ �(kJ
J MAIL _
BLOCK TRACT ✓ O ADDRESS O S� /� �>'7�/C/` �•A'`� �,gLyP
NOOF B
SIZE OF LOT NOW ON LOT CITY r— elf TEL, NO,
USE OF DISTRICT NO, GRO MAA PROCESSED BT
BUILDING. /G //�
CONTRACTOR
d V r BK
- ADDRESS CONNECTION DATA
CITY TEL. NO, STATION DEPTH
STATE LICUPPER
LICENSE NO, CLp55 MANHOLE DEFERENCE
LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH ER
OM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P..L L,
PUBLIC SEWER 55.00
SEPTIC TANK.SEEPAGE PIT OR
P.C.NO.
I PITS PND/OR DRAINFIELD 0 SIO.00 CO.IMP. NO. JOB NO. �
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N0. (L
PRIVATE DISPOSAL SYSTEM Q S3.00 p � O
COMM ECT wDOITIONALB V AFFIDAVIT qv s[Y[ gECOflO.IN3TR.N0. DATE U
WORK TO HOVSE BEW ER Q 53.00
OVERFLOW SEEPAGE PIT.DRAINFIELO / OC
EFTN.,CESSPOOL.DRYWELL.MANXOLE B BSGO
ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING (�
SEWER OR DISPOSAL SYSTEM 0 53.00 W
STATEENCROACHMENT d
PEPMIT NO. ^J CC
Z
INOVBTRIAL
WASTE APPROVAL 4-11 160
OWNERS PERMIT s z oo CHARGES
AiTTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR THIS
THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE. INS TOR'. ATI-RIE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT_ CONNECT ADDITIONAL
'ADDRESS BUILDING OR WORK
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK.SEEP,PIT(S)
PND/OR DRAIN FIELD
AND STATE THAT THE ABOVE IS
CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ ORYWE" ❑
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE DESCRIBED ESIDEN IAL PROPERTY. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS
OF PERMRTEE - ❑
SEEP.PIT151 ❑ CESSPOOLS VALIDATION JACK R. ALLEN
SUPERVISING MECHANICAL ENGINEER
CK.
M.0. CASH
4 6 5 I APR 24 1 0 0 5:00- v