HomeMy Public PortalAbout6041 ENCINITA AVE_Sewer__ 7`99 G%No. S9a
FT, a Fa3 X 3 S-,cT. f L vY �� / CS°pFAl1FT
: /03. FoF -
GaT 377 '� �%
C 6 08 1 � -
6A642 0-63 APPLICATION FOR PERMIT 1
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER _
BUILDING AND SAFETY DIVISION Aoov Iss 60 L'//I1/r�
JOHN A. LAMBIE. County Engineer
WILLIAM A. JENSEN. Supt of Building LE �./T
LOCALITY
FOR APPLICANT TO FILL IN N AREBT
CRO54 ST. \,�rJ-�//•J/rL-�[/ / /moo
LEGAL h/r/VC�� C�/y
DESCRIPTION LOT NO. OWNER 'z�--J-r_�—�
MAIL _ _
BLOCK TRACT O ADDRESS 0 NC/ 17
��J / y'
NO. OF BLDGS. �� I�C'/T TEL. NO.
SIZE OF LOT 1� /' NOW ONq LOT
DG /� L CITT L
BUILDINGS /70 USG (2-///f t9l� L
DISTRICT NO. GI MAP PR CESSEO BY
°` 'yE R E2NEST �'• .S/�,d.0 L C,P � .� L/ K �o
ADDRETss J E /C T ✓� CONNECTION DATA
CITY �r� �a/V 9 STATION DEPTH
F STATE MANHOLE REFERENCE
REGISTRATION NO. B COUNTY .� LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTI N LENGTH FROM
HOUSE SEWER CONNECTING TO T. CURB F.L. M.L.TO P.L. }
PUBLIC SEWER
SEPTIC TANK.SEEPAGE PIT OR ,./ P C NO O
PITS ANO/OR DRAINFIELO 0 310.00 CO.IMP, NO. y JOB NO. V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. V ROAD PERMIT NO. w
PRIVATE DISPOSAL SYSTEM @ 53.00 �L,n ^
CON N ECT ADO ITI ONAL•l%T Vv AFFIDAVIT ) W [.5[N[XI RECORD. INSTR.NO. DATE F
WORK TO HOUSE SEWER ® 53.00 1 ^ p v
OVERFLOW SEEPAGE PIT.DRAINFIELD _ _� �f 1]� CL
EXTN.,CESSPOOL,DRYWELL,MANHO LES 35.00 NWT.OR ST.WIDENING /- v /
ALTER.REPAIR OR ABANDON HOUSE �f
SEWER OR DISPOSAL SYSTEM 33.00 STATE ENCROACHMENT L
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
OWNER'S PERMIT Sl 21 00
O^\ CO CTION CHARGE FEE CHARGES
AUTHORIZATION TOTAL FEE
'1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC BE E APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS /DRAY `OF igl
',; E � / S / `/ S A LC/\ NEW HOUSE SEWER
/�/ LJ CONNECT ADDITIONAL ���I-
ADOREES `O �� • . E'Nc/,yi7 /�Vt-A BUILDING OR WORK YS
SEPTIC TANK.SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER.REPAIR,SEWER OR
LICENSED AS REOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE ABOVE DESCRIBED RE DENTI L PROPERTY. ABANDON HOUSE SEWER
SIGNgTURE Bq CKFILL SEPTIC TANKS ❑
OF PEPMITTEE� _ ❑
SEEP.PIT(SI ❑ CESSPOOLS
VALIDATION ROBERT WOOD SUPERVISING MECHANICAL ENGINEER
CK.
M.0. CASH
: o12 A9Q .:.'S 21 0 5.00-