HomeMy Public PortalAbout6038 ENCINITA AVE_Sewer__ ]6Al642D-CE808-10-]1 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER -
BUILDING AND SAFETY DIVISION eu1LDINc / _03 vC
ADDRESS C� LC�!
LOCALITY
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NEAREST
FOR APPLICANT TO FILL IN
CROSS ST. 6� v�w��L7
LEGAL •C�+ /I��II /'•1�� /!A
DESCRIPTION LOT NO, a.�/�` E OWNER ✓✓I/ F// Z� /l�]31//}V �///y�J'
/". / MAIL yam/a U` A/\ vle / / / V r'
BLOC. TRACT ADDRESS
NO. OF SLOGS. /`VlJC �LI{./TN TEL.
SIZE OF LOT NOW ON LOT CITY
UBE OF �Q�) DISTRICT NO. GROUP j$1 L{ MAP C_ PR ESSED BY
BUILDINGS .
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...TRACTOR SS V(\e"'1p DMc /M -.5 o ,L-
ADOREss 3ZI'16 Gh/tffy AVE (, CONNECTION DATA
CITY USE^M{(�^A! JD [STEL. NO.SJ3�C7517 STATION DEPTH
L UPPER
LICENSE NO.Jx li / �! QJ CLP55 B V MANHOLE REFERENCE LOWER
NO. .DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER $7,00
SEPTIC TANK.SEEPAGE PIT OR P.C.NO.
PITS AND/OR DRAINFIELD 310.00 CO.IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. C_
PRIVATE DISPOSAL SYSTEM 33.00 O
CONNECT 4DOOI TION AL BIO. OR !/.v.•iY�+ �� AFFIDAVIT wAIY!! 5[x!x RECORD,INSTR.NO. DATE V
W]°si' USE SEWER 53.00
OVERFLOW SEEPAGE PIT.GRAINFIELD
EXT...CESSPOOL,DRYWELL. @ S5 Do HWY.OR STWIDENING O
ALTER.REPAIR OR ABANDON HOUSE . , F_
SEWER OR DISPOSAL SYSTEM 13.00 STATE ENCROACHMENT W
MANHOLE $T Op PERMIT NO. D_
INDUSTRIAL
�}� WASTE APPROVAL Z
OT{�TIYLR'S PERMIT OD CHARGES
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED Co. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTORS SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR f�`!5Ul� /�,0 •fQ�L NEW HOUSE SEWER
OWNERS AGENT JJJV q C/J /T L //11/0 - CONNECT ADDITIONAL
40DRE55 C BUILDING OR WORN
SEPTIC TANK.SEEP.PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIEL.
AN. STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS, CESSPOOL ❑ DRYWELL ❑
HEREBY 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 1 AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE AB DESCRIBED ESIDENTIAL PROPERTY, ABANDON HOUSE SEWER
SIGNATURE
OF PERMFT BACKFILL SEPTIC TANKS
— ' SEEP.PIT 151 Q'CE SPOOLS
LIDATION CX' M,O, CASH
021 1,.• 11u U 9.0oaT,