HomeMy Public PortalAbout6105 ENCINITA AVE_Sewer__ 7GA6420 APPLICATION FOR PERMIT
BaEaBDIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer - E/JC/�/7
County of.Los Angeles BUILDING / f"� �/
JOHN A. LAMBIE. COUNTY ENGINEER ADDp ESS CJ ✓ / -/ nV
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY T G S
t FOR APPLICANT'T81'ILL IN NEARESTLEGAL
DESCRIPTION �OT NO. ��� � ��� OWNER
MAI
BLOCK TRACT (�,/}(� ADDRESS
NO. OF BLDGS. /
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF • DISTRICT
NO.
GROUP MAP
BUILDING$
L BK PG
CONTRACTOR C Q . ' L~ 1 y
� ` CONNECTION DATA
ADDRESS
STATION p DEPTH
CITY S•�• C}�• TEL. N0. aY. �j A MANHOLE REFERENCE UPPER
�� 7
[:1 STATE R
REGISTRATION NO. ❑ COUNTY .
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF IN TION LENGTH FROM
--fl Y. CUR P.L. M.L. TO P.L.
PUBLIC SEWER @ $3.50 V
SEPTIC TANK,SEEPAGE PIT OR ,
PITS AND/OR DRAINFIELD @ $ 3.00
OVERFLOW SEEPAGE PIT, DRAINFIELDp' P. C. NO.
EXTN..CESSPOOL.DRYWELLMANHOLE @ $ 2.00 CO. IMP. N0. J Z p JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. d�D
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ S 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ S 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00—
AUTHORIZATION TOTAL FEE O REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA ED CON- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. ��ll NEW HOUSE SEWER
SIGNED THIS DAY9F 19J ! CONNECT ADDITIONAL
LADDRESS
OR / T / BUILDING OR WORK
S AGENT_/! �" SEPTIC TANK,SEEP,PIT(S)
SS .ANO/OR DRAINFIELD
REBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑TATE THAT THE ABOVE ISCORRECT AND AGREE TO COMPLY
ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
ING AND SEWERS. SEWAGE DISPOSAL SYSTEM
EREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR pISCONNECT PLUG ANDSED AS REpUIREO BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
ORNIA OR Th T I AM THE LEGAL OWNER OF TH ABOVEIBE RESID TIAL PROPERTY. BACKFILL SEPTICTANKS❑ 17/�f /�/,T SEEP. PIT($)-❑ CESSPOOLSO `ER T E •�,-, /
JOHN A. LAM . COUNTY ENGINEER VALIDATIOPy" , ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. /�/CA/SH/
I 3 5 2 2—L I'M 2 0
� 4 p 4.5 0 In .