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Home My Public Portal About6045 ENCINITA AVE_Sewer__ °6°°'21002 76A0e20 APPLICATION FOR PERMIT CJI COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL illi DEPARTMENT OF COUNTY ENGINEER ( BUILDING AND SAFETY DIVISION auILw NG ��Ui Cly OHN A. LAM LE. County Engineer aooaess U WILLIAM A. JENSEN, Supt of Building �j LOCALITY `• NEAREST FOR APPLICANT TO FILL IN `EARS $T. c>S LEGAL DESCRIPTION LOT NO. 3 /" o[ '�" /y OWNER /CT MAIL BLOCK TRACT � ADOflESE -�� NO, OF BLOGB. SIZE OF LOT/ NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP PFyCEBSEO BY ORCONTRACT ADDRESS o `e—�V"`(�•✓/'� I / CONNECTION/D A+TA -CITY YjN/ TEL. NO, 332 ifs S TON EPTH STATE MANHOLE REFERENCE REGISTRATION NO / - �J J COUNL UPPER `\ NO. DESCRIPTICTN OF WORK FEE TYPE OF CONN E TI J LENGTH FROM HOUSE 5EWER CONNECTING TO Y. C P.L. ..L,TO F. . PU BLIC SEWER ® $3.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR PITS qN0/OR DRAINFIELO ® 310.00 CO.IMP. NO. JOB NO. -/ HOU5E SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. yd PRIVATE DISPOSAL SYSTEM 33.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT w%IY[[ [%[[Y[Er RECORD.INBTR.NO. DATE W WORK TO HOUSE SEWER ® s3.00 a OVERFLOW SEEPAGE PIT,DaAI FIELD H E%TN..CESSPOOL,DRYWELL. LES 83.00 Z ALTER, RE OR ABANOO RE HWY.OR ST.WIDENING SEWER OR OISPOSA EW'F STATE ENCROACHMENT PERMIT NO. / INDUSTRIAL 1 rl�/ / WASTE APPRO VqL CHARGES OWNERS PERMITs r�o-- AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVEATTHIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECT 'SS NATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTICTANK.SEEP.FIELD PIT(S) I HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION ARD/OR DRAINFIELD ANO STATE THAT THE OINA IS CORRECT AND AGREE E COMPLY WITX ALL COUNTY OROINA NCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYW ELL ❑ IHEREBY CERTIFY THAT r AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PWG AND RESIDE IN, TME ABOV sC WT"RESIDENTIAL PROPERTY. . ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMIT BEEP.PIT I51 ❑ CESSPOOLS ❑ VALI ATION ROBERT A. WOOD crc. M.0 cwsH SUPERVISING MECHANICAL ENGINEER L&O 8 4 2' SEP3 0 1 1 D 2 5.00- v CEBOB ID.E2 TE 86b 1 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONA DRE S O JOHN A. LAMBIE,-County Engineer DDREs WILLIAM A. IENSEN. Supt of Building LOCALITY NEAREST FOR APPLICANT TO FII.L IN CRDSB ST. JAL _ DESCRPTION LOT NO. 7L L OWNER MAIL ' BLOCK TRACT O� ADDRESS a}.[, NOW OF BLDGS. 2 SIZE OF LOT /) ^/ NOW ON LOT ! _ CITY TEL. NO. USE OF --P— USE ONGS DIBTRICTN°. GROUP MAP PROCESSED BY ER_HJ BK PG q CONTRACTOR _ a..l[T _ ��l ADDREss D / ��p`; yJ CONNECTION DATA CITYUz Co(�/ TEL. NO. O ATION DEPTH A Q Q�STATE ^� `/ ♦ PPER } REGISTRATION NO. / J � • ❑ COUNTY MANHOLE REFERENCE NO. DESCRIPTION OF WORK FEE TYPE OF CONNE - N LENGTH FROM f O H OUSE SEW ER CONNECTING TO Y. �� P.L. M.L.TO P.L. PUBLIC SEWER ® 55.00V- �� P.C.NO, p( SEPTIC TANK.SEEPAGE PIT OR . JOB NO. O PITS pND/OR GRAINFIELD ® f10.00 Co.IMPNO. _ r HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. LJ PRIVATE DISPOSAL SYSTEM $3.00 IIIYYY CONNECT A-1I QPp OLOG.OR AFFIDAVIT wMvu 5[R[rf RECORD. INSTR.NO. DATE d WORKTO HOUSE SEWER 33.00 H OVERFLOW SEEPAGE PIT,ORAINFIELD E%TN..CESSPOOL.DRYWELL.MA NHOLE 0 $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY,OR ST.WIDENING SEWER OR DISPOSAL SYSTEM W 33.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL ^ WASTE APPROVAL CHARGES OWNERS PERM Tf sz 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE 'PURL IC SEWER. APPROVALS DATE INBPECTOR'SSIGNATUNE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER ' OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR GRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL I 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 I AM THE LEGAL OWNER OF, AND INTEN° TO DISCONNECT PLUG AND RESIDE IN. THE ABOVE D CRIB RESIDENTIAL PROPERTY, ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ BEEP.PIT(3) ❑ CESSPOOLS VALIDATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. LA[;0 0 6 4 IQ SEP 3 0 1 0 0 7.0 0- v _ �rf