HomeMy Public PortalAbout6046 ENCINITA AVE_Sewer__ 76AG42DAPPLICATION-tOFOR PERMIT
6 S[-66-663 3.55
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL.
DepGTtment of Covntp.Engineer REM
BU7A1\
County of Los Angeles AD
ORESBG !WM.J. FOX, COUNTY ENGINEER CASSATT D. GRIFFIN. SUPT OF BUILOING LOCALITYFOR APPLICANT TOFILL IN NEAREST
CROSS ST.LEGDESCRIPTION LOT NO. r. � J ^ / a(. OWNER , I
MAIL
BLOC+R.�'�r TRAC ,�. ,.�„E A DRESS -
SIZE'OPLOT� LOT$ CITY TEL. N0.
USE OF
BUILDINGS DISTRICT NO: GROUP MAP
BK PG
~ CONTRACTOR � � / Er 1 •-i
1 `
ADDRESS "� .^r. �" iy--(i f '�l-. o CONNECTION DATA
CITY � V j'ATEL. NO. �� I JIG` 7 STATION DEPTH V
/ /� [STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. / - ry- (.--1 C] COUNTY LOWER
No. DESCRIPTION OF WORK FEE �- � •i s, �(A C.i h ...�,�5 •~
'ITYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER @ $ 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR L CO. IMP LSO. JOB N O
WORK TO HOUSE SEWER 1.00 �-
pLTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT r
1 AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK. SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 00 INDUSTRIAL
. , \•
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 `amu CHARGES
PERMIT CONNECTION CHARGE FEE \•
OWNER'S S 1 00
AUTHORIZATION TOTAL FEE r C •� REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED COR-
TRACTOR
O -TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE\ INSPECTOR'S SIGNATURE
TG,.HE PUBLIC SEWER
' SIGNED THIS DAY OF 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
/ SEPTIC TANK.SEEP, PITS)
ADDRESS ANO/OR DRAINF15LD
I HEREBY ACKNOWLEDGE THAT 1 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 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPEqRTY. BACKFILL SEPTIC TANKB['
/` {.�J�/ SEEP. PIT(S) ❑ CESSPOOLS❑
SIGNATURE /tri
OF PERMITTEE
WILLIAM J. FOX COUNTY ENGINEER VALIDATION R.A. ,W{{OOD. CHIEF
PLBG.}}INSPECTOR
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