HomeMy Public PortalAbout6012 ENCINITA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEINER-SEWAGE DISPOSAL If
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION JS
.u� COUNTY OF LOS ANGELES .
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
i1,U''• ADDRESS _ o /'Y4 A _
V FOR APPLICANT-TQ FILL IN LOCALITY TmKJle Cit„BUILDING /
[ADDRESS
/fes. NEAflEST i,/OO / /lL G' ,l /� y„_CROSS ST. W C� CYlJ /I V"CCALITY � • ; y DISTRICT NO. SERIIAAL/,NO. P^ERMIT NO.
AREST II / /' �,( A /QJ � Qy `JOSSSTRECEIVED BY Ready for Inapectlon DDATEISSUED
NER 5,9i /f�. /3-G.
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ADDRESS 2480 RA IOrM Rill 11 NAM JOB.NO. JJ rrl7
CITY LOS ANGELES 33 r C�NOFORNIA TRUNK PERMIT NO. ---
REGISTRATION N0. ANgeiu$ 3'3886ro J.gS� COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. J O . O� '&�[o// PERMIT NO.
BLOCK TRACT COV�S INDUSTRIAL
WASTE APPROVAL
N0-
0OF BLDGS. n
SIZE OF LOT ZTP NOW ON LOT CHARGES
USE OF
BUILDINGS s. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
-- - NOOSE CONNECTING TO
PUBLIC SEW SIEWE ER Q $ 3.50 G RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO �-
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO. I DATE I BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00
0ISCONNECT AND AND/OR DISPOSALS STEMN SEWER 1.00 CONNECTION DATA
S EPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION 67-7 , D DEPTH �
SPECIALCONDITIONS ONLY 2.00
5`T 1 .11 O / MANUPPERREFERENCEEFELOWER
TYPEOFCONNECTI ON LENGTH FROM /
OWNERS PERMIT { I 00 Y. CURB L/ P.L. _ M.L.TOP.L. �fD
AUTHORIZATION I TOTAL FEE
1HAVE 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 OF---_......... .......... 19..._... r
OWNER OR - CONNECT ADDITIONAL `
OWNERS AGENT.. {��- �{\�� BUILDING OR WORN
____ ___ __ _ _ _ _ SEPTIC TANK.SEEP.PIT(S)
ADDRESS..............._......_.........................._. AND/ORD RAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL[3 DRYWELL E]
CATION 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
I HEREBY CERTIFY THAT 'I AM PROPERLY REGISTERED DISCONNECT PLUG AND
ANO/OR LICENSED AS REQUIRED BY LOS 'ANGELES COUNTY
AILD STATEOF CALIFOBJUA OR lHAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE CB R IDENTII'L PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E] CESSPOOLS 1-jI C/SLC lla// J cJ
SIGNATURE
OF PERMITTEE..........._._....._.........._....... _ ....._.................._. L
1GA6421) 663