HomeMy Public PortalAbout6015 ENCINITA AVE_Sewer__ DEPARTMENT O�' COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDINGj,� ��/I ,' ILL
NEAREST
ADDRESS 0 .I ! so �.//l+t� dWLG _CROSS ST.LOCALITY
NEREST �LA� A' I ^T� r ISTRIC� A SERIAL NO. //PERMIT
��1 NO. C
CROSS ST. nJ,/Q�r i�+,�,a �.•I IJ
p�,� �� fJ (� ftE/C E^1 VAED OY Ready for Inspection DATEISSUED,9
OWNER r\4G • sA�bdlJC-X.�.LJ r '
MAIL USEZONE OCCUPANCY MAP
ADDRESS _.,[�/rf73!>/L� BK PG
CITY y�� i� *l TELAO.
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CONTRACTOR,/c/&:�,d'ed Sir i� .�ld 1:� /r�j 7 tS Q �(4
CO.IMP.N0.
ADDRESS5{' y�"N+i G/ JOB.NO.
CITY T-t /7TELAO. Ll•Z/%,,2/ TRUNK PERMIT NO.
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REGISTRATION NOT / �-J `® COUNTY ROAD PERMIT NO. as ob 3 6
LEGAL S f/j�aWei
p STATE ENCROACHMENT
•
DESCRIPTION L�T 0. Ll W{ Iqq PERMIT NO.
BLOCK TRACT A:!q �� 1J 0 � • INDUSTRIAL
' �N WASTE APPROVAL
512E OF LOT D o N0. ON LDGS. wy
',1 - NOW ON LOT/p/ d'� CHARGES
BUIOF
LDINGS . LcLt.�.c.�9 ICA11 9;-f CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK ' FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO'
PUBLICSEWER s' R $ 3.30 3 .h C. RECEIPT NO. I DATE) IBY
HOUSE SEWER CONNECTING TO
P RIVATE DISPOSAL SYSTEM I.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORKTOHOUSESEWER 1.00
ALTER OR REPAIR EXISTING NO'il/ DATE\ BY -
SEWERORDISPOSALSYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA 1
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 I STATION /n �CO`� DEPTH ( /
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / el MANHOLE REFERENCE
n N UPPER _ —LOWER,
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 I DD YT CURB —`.L. M.L.TO P.L. K
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEW �I
SIGNED THIS..............._...DAY OF 1 •�._._.iL..__...IYL• NEW HOUSE SEWER A s`
OWNER OR
. . .. ....1...._/._/�''. �•�_...._Q._.�. ...
CONNECT ADDITION
AL
OWNERS A ENL/ . a_.I)/ BUILDINGORWORK
SEPTIC TANK.SEEP.PI
TS)
ADDRESS � %7Bu �S /m ......... AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL Q DRYWELL
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 NECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT I AM THE.LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
I SEEP.PIT(5)Q CESSPOOLS s
SIGNATURE 3 et
OF PERMITTE, .... __n�- � ::���a•-.'C
76A642D 663 1/33