HomeMy Public PortalAbout6039 ENCINITA AVE_Sewer__ CE807SA64 APPLICATI N FOR PERMIT (. l 0?7 )
8 00
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
OHN A, LAMBIE, County EvgqineoT ADDREll
WILLIAM A. JENSEN, Supt of Building LOCALITY
"tA EST
FOR APPLICANT TO FILL IN
CROSS STLEAL .
DESCRIPTION LOT NO.-�Or3Vt 37HER p /
BLOCK TRACT 0,'- 7/6 MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO
USE OF
BUILDING Lam- .cmc-L DISTRICT X0. GROUP YAP PROCESSED BY
CONTRACTOR Ay` C,Q /1 I BK PO
L
ADDRESS y (/ v2 _ . CONNECTION DATA
CITY �. G�_ •TEL.NO. P )/ STATIJK DEPTH
STATE MANHOLE REFERENCE /
REGISTRATION NO. Y(J 'Y.f7il e COUNTY /� LOWER
ND. DESCRIPTION OF FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ s .00 O�
SEPTIC TANK,SEEPAGE PIT OR TYP CONN T LENGTH FROM
PITS AND/OR DRAINFIELD @ S .00 Y. CU P.L. N.L.TO P.L.
OVERFLOW SEEPAGE PIT.GRAINFIELD }
EXTN..CESSPOOL.DRYWE LL @ S .00 CL
NOOSE SEWER CONNECTING TO 47P.C.NO, O
PRIVATE DISPOSAL SYSTEM @ S 00 CO.IMP. N0,' JOB N0. L)
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. s pr
WORK TO HOUSE SEWER S .00 O
S EWER OR OIISPOSRL SYSTEM
ROUSE @ S .00 STATE ENCROACHMENT
PERMIT N0.
INDUSTRIAL W
WASTE APPROVAL CL
N
c. CHARGES Z
OWNERS PERMIT S 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HE EIN NAMED CON n
TRACTOR TO CONNECT THE ABOVE DESCRIBED 71STING DWE IN APPROVALS I DAIE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. rr
SIGNED THIS DAY F ` 1 NEw xOusE sEwER �Li V!��
OWNER OR CON NECT ADDITIONAL I1
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR.SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY ?
I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOU BY L65 ANGELES COUNTY AND STATE OF ABANDON NOOSE SEWER
CALIFORNIA OR AT I A1 THE LEGAL OWNER OF THE ABOVE
DESCRIBED RES NTIAL P PERTY. BACKFILL SEPTIC TANKS ❑
EP SEPIT S ClCESSPOO
SIGNATURE LS
OF PERMITTE C-
/ VALIDATION ROBERT A. WOOD/
L
It.0. (�W�N SUPERVISING MECHANICAL ENGINEER
LA;:GO 9 5 8 AFF 12 1 0 0 17.0 0
76A642 -61 APPLICATION FOR PES MIT
a 3 � �l
COUNTY OF LOS ANGELES SEWER=SEWAGE DISP AL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DNISION BUILDING `
IOHN A. LAMBIE. CiouLIY Enggineer ADDRES /' L
WILLIAM A. IENBEN, Sup'I o1 Building LOCAL TY (�
NEARER I /
FOR APP CANT T IN CROSS .
LEGAL �� OWNER
DESCRIPTION LOT N0.
BLOCK TRACT MAIL
ADDRESS �.-
NO.OF SLOGS.
SIZE OF LOT NOW ON LOT If CITY TEL. NO
USE OF
BUILDINGS BK PG DISTRICT NO. GROUP MAP PROCESSED BY
CONTRACTOR Q �. L,Q (f�� 14 1
ADDRESS ti/ T S� Q ONNECTION DATA
CITY L A TEL.NO ¢ 'y• STATI DEPV..I1 \
r STATE MANHOLE REFERENCE
REGISTRATION N0. COUNTY i•��L� LOWER
No. I DESCRIPTION OF WVHA FEE \
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $:.D0 TYPE OF CON E LENGTH FROM �}}
SEPTIC TANK,SEEPAGE PIT OR T. C ^P.L. N.L.TO P.L. •Y
PITS AND/OR DRAINFIELD ' p @5 .00
OVERFLOW SEEPAGE PIT,GRAINFIELD
EXTN..CESSPOOL.DRY
@
S! .00 0.
HOUSE SEWER CONNECTING TO P.C.N0. O
PRIVATE DISPOSAL SYSTEM @ 51 00 CO. IMP. NO• JOB N0. U
WORK CONNT
ADDITIONALOUSE BLDG.
SEWER
OR @ $I 00 TRUNK PERMIT NO. ROAD PER NIT N0. OC
TO ALTER,OEPISPORA SYSTON HOUSE @ 5 00 STATE ENCROACHMENT O
SALPERMIT NO. IU
INDUSTRIAL d
WASTE APPROVAL N
� e CHARGES ?
O•`lNEfr5 PERMIT $ CONNECTION CHARGE FEE
AUTHORIZATION r TOTAL FEE REIMBURSEMENT FEE
NAMED
TRACTOR TO CIONNECT THE ABOVH DESCRIBED EXIISTDATE A CONTRAWITH THE IING DWELCONG APPROVALS RATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. ' ///'//
SIGNED THIS DAY OF 1 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL 1 •1 .�/
OWNERS AGENT BUILDING OR WORK !7l/
ADDRESS SEPTIC TANK,SEEP.PIT(S)
I j BH
wAv
AND/OR DRAINFIELD 'Y
1HEREBY ACKNOWLEDGE THAT lHAVE READ THIS APPLICATION I ' I U
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS./' SEWAGE DISPOSAL SYSTEM
I HEREBY CER THAT 1 ROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSEff
O RED BY L GELES UNTY AND STATE OF ABANDON HOUSE SEWER
CALIFOR THAT 1 AM HE EGAL 0'NER OF THE ABOVE
DESCRI ENTIAL PRO RTY. BACKFILL SEPTIC TANKS ❑
SEEP. ITIS ❑ CESSPOOLS
SIGNA U
OF
i
VALIDA ON---I ROBERT A. WOOD
cK. B.o. WH SUPERVISING MECHANICAL ENGINEER
i
00959 APR1211 0 25 .00 . ` '
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