HomeMy Public PortalAbout6118 ENCINITA AVE_Sewer__ 7 420
-. .APPLICATION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING
6118 N. Encinita Ave .
JOHN A. LAMBIE. COUNTY ENGINEER
® CASSATT D. GRIFFIN, SUPT OF BUILOING LOCALITY Temple City
NEAREST Garibaldi
FOR APPLICANT TO FILLIN moss ST.
LEGAL Por ot 4 OWNER Marren P. MCMille'n _
DESCRIPTION LOT N0. c. o_ N.
BLOCK 1. TRACT Santita MAIL 6118 IS. Encinita Ave.
n +z+gnd CO. ADDRESS .
SIZE OF LOT `O g �Q� NONLOT3 CITY Temple City TEL. NO. AT 77902
USE OF
I BUILDINGS residence & a a DISTRICT NO. GROUP MAP
��. BK PG
CONTRACTOR Owner 6n 7 3
- CONNECTION DATA
ADDRESS
_ STATION DEPTH
CITY tEUN
MANHOLE REFEREE UPPER
❑ STATE LOWER
REGISTRATION N0. ❑ COUNTY
NO. DESCRIPTION OF WFEE
HOUSE SEWER CONNECTING TOTYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER '$3.50 Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD � $3.00OVERFLOW SEEPAGE PIT, DRAIEXTN..CESSPOOL,DRYWELL,MA@ $2.00 CO, IMP. NO.HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEMQ S 1.00 TRUNK PERMIT NO.' ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OSTATE ENOROACHWORK TO HOUSE SEWER@ .51.00 1 00 PERMIT N0.
ALTER,REPAIR OR ABANDON HINDUSTRIALSEWER OR DISPOSAL SYSTEM $1.00 WASTE APP AL
CHARGES
CONNECTION CHARGE FEE
{ OWNER'S PERMIT S Do.
AUTHORIZATION TOTAL FEE 2 00 REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH-THE HEREIN NAMED CON- ' APPROVALS DATE INSPECTOR'S SIGNpT URE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. - NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION r 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 DISCONNECT PLUG AND
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGASE D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. Q� BACKFILL SEPHOU-TIC TANKS 73
SIGNATURE W �/�p,^ Y�LW"'1 SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
[X. Y.O. CCAS -
4 8 1 3 DEC 4 4 2.C?0