HomeMy Public PortalAbout6023 ENCINITA AVE_Sewer__ E-6D
9 APPLICATION FOR PERMIT
aE.BeDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Aageles BuaDINc '/�•' '
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
® CASSATT B. GRIFFIN. SUP'TOF BUILDING
LOGLIT n � ,y
FOR APP((L��ICAN//T T/O FIrrLL INNEAREST
ROSS ST. '
-DESCLEGRIPTION LOT NOSAU+k u? f4'ge+ CIF S;? OWNER S
BLOCK TRACT MAIL
_ 5 qqo 4 ADDRESS
Y �C
N0. OF BLDGS.1 CITY w TEL. NO.
SIZE OF LOT-7� �C 2Lec NOW ON LOT �L✓(j
USE OF
BUILDINGS DISTRICT N0. GROUP MAP
sBK PG
CONTRACTOR L ,
Q1.
r ✓ CONNECTION DATA
ADDRESS 7 /G L Q
t t STATION l � 1 . D DEPTH G
CITY TEL.
•- MANHOLE REFERENCE U PER
❑ STATE 1 \. LOWER
REGISTRATION N0. S ❑ COUNTY
NO. DESCRIPTION OF WORK 44E
HOUSE SEWER CONNECTING TO TYPE OF C-{�{fLECTION LENGTH FROM
_ PUBLIC SEWER @ $3 Y. /C`O Rq� P.L. M.L.TO P.L.
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD l i P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. 1 �1 JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ S 1.00 TRUNK PERMIT NO. ROAD PERMIT 143 t�
CONNECT ADDITIONAL BLDG.OR R STATE ENCROACHMENT
WORK TO HOUSE SEWER @ S 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
_ CONNECTION CHARGE FEE
OWNERS PERMIT g 7 pp {
AUTHORIZATION TOTAL FEEz"t REIMBURSEMENT FEE ��n
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'SS GNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. A C� NEW HOUSE SEWER
SIGNED THIS D OF N
AL
OWNER OR ` BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(S)
ADDRESS ANO/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCABANONNECT
CT PLUGHOUSE AND
CALIFORNIA OR THAT I THE LEGAL,,009RPRRREEER OF THE A VE e
WER
DESCRIBED RESIDENTIA PERT / BACKFILL SEPTIC*TANKS❑
SIGNATURE SEEP. PITS) ❑ CESSPOOLS
OF PERMITTEE i
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD.,CHIEF PLBG. INSPECTOR
CK. M.O. CASN
L o 5_ � I IitY 71 0 A 5.0 0