HomeMy Public PortalAbout6108 ENCINITA AVE_Sewer__ DEPAIVrMENT OF COUNTY ENGDYEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
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ADDRESS � O � . �1'l✓`J// TLOCALITYIC7 N0. ♦ SERIAL NO. ^ PERMI/T N0.NEAREST pr/ a ! ~ 743 / Div 6CROSS ST. VED ReaEy for Inrvecllen DATE 6-S3
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ADDRESS •Oi
10B NO. -77
CITY LO �. TEL.RO(f�- 1 / TRUNK PERMIT NO. '-�
REGISTRATION NO. �/J �� 0 COUNTY -2 4 ? 7-57e 57e
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DESCRLEGIPTION LOT NO.Y�/1so.4 n koA D/•y STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACTsj INDUSTRIAL
WASTE APPROVAL
/ � NO.OF BLOCS.
SIZE OF LOT h
NOW ON LOT i' CHARGES
USE OF
BUILDINGS �Jlol�_Ootr -
CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE I
HOUSE SEWER CONNECTING TOO REIMBURSEMENT FEE
PUBLIC SEWER (� $ 3.50 _� RECEIPT NO. DATE IBV
HOUSE 8EWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 1
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO' I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.06
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS ARD/OR DRAINFIELD 2.00 STATION �� jr 3 DEPTH
CESSPOOL-ORYWELL
SPECIAL CONDITIONS ONLY 2.00 /�/�IqN OLE ft�EERENCE
1�� �J'f t7PRrER-' �I LOWER
TYPE OFC NECTION LENGTH FRO
OWNERS PERMIT ; 1 11
y00 CURB rw
AUTHORIZATION TOTAL FEEI sa
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED I
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PLIC SEWER `` _ -
SIGNED THIS......�.-------------------- VV NEW HOUSE SEWER
e = CONNECT ADDITIONAL
OWNER OR _ �/�/�Y�L/--Y BUILDING OR WORK
OWNERS AGEN
ADDRESS...... .L1A..L/..1... /LN.CIJLI-QC....._..._._.:_..._ AND/OR DRASEPTIC INFIELD IT/S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL E]
CA
TION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSESAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED JWIDENT AL PROPERTY. BACKFILL SEPTIC TANKS ,
1<!- /�/ SEEP.PITS) CESSPOOLS"Q.
SIGNATURE � .(+LT/
' OF PERMITTEE.. .. ...._._ ......_....._....... .
76A042D 663 1/53 �,� ( J