HomeMy Public PortalAbout6125 ENCINITA AVE_Sewer__ IS 76 642 1159 A�PPLICA►TION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer - - -- -- - Q
County of Los Angeles Bu1LDING
JOHN A. LAMBIE. COUNTY ENGINEER AGGRESS
® CASSATT D. GRIFFIN. SUPT OF BUILDING LOCALITY -
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FOR APPLICANT,,
TO ILL IN CROSS ST.
o LEGAL #I ot-j X, / O� OWNER
DESCRIPTION LOT NOS 2
Q
BLOCK TRACT MAIL�90 ADDRESS
NO. OF BLDGS. CI7Y - TEL. NO.
SIZE OF LOT NOW ON LOT
- USE OF
BUILDINGS DISTRICT NO. GROUP MAP
CONTRACTOR /--- /- •_G
F ADDRESS CONNECTION DATA
�y STATION l� DEPTH
CITY TEL, NO. KIQ
C
MANHOLE REFERENCE/j - /f� UPPER
v 14 REGISTRATION NO. 3 U 7 ❑ COUNTY t�/'�/ LOWER
NO. DESCRIPTION OF WORK FEE _
j HOUSE SEWER CONNECTING TO TYPE OF ION LENGTH FROM.'
1 Y.PUBLIC SEWER @ $3.50 CURB P.L.
S EPTIC TANK,SEEPAGE PIT OR
ITS AND/OR GRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. GRAINFIELD P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MAN HOLE I} $2.00 CO. IMP. NO. . JOB N0.
HOUSE SEWER CONNECTING TO - /J
PRIVATE DISPOSAL SYSTEM $1.00 TRUNK PERMIT NO. ROAD PERMIT N0.% l a�
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER C $1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Fp S I.00WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE-
OWNER'S PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS GATE A CONTRACT WITH THE HEREIN MED CON-
APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR
RTO O EWER.
ABOVE DESCRIBED EXISTINGISTINGDWELLING
TOTHE PUBLICS
NEW HOUSE SEWER
SIGNED THIS ,<= U AY OF- 91AI"ll' 19 J D CONNECT ADDITIONAL
OWNER ORA�� II BUILDING OR WORK
OWNERS AGENT t /, WL/ j�
_ SEPTIC TANK,SEEP.PIT(S)
AGGRESS t - AND/OR GRAINFIELD ;
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[IDRYWELL L3AND 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 R£OUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT AM THE LEGA OWNER OF THE ABOVE _
DESCRIBED RESIDENT A ROPER ` BACKFILL SEPTIC TANKS❑ f
SIGNATURE SEEP, PIT(S) CJCESSPOOLS 1kn
OF PERMITTEE ...
JOHN A. LAMBIE, COUNTY LNGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. N.O. CASH '
f A�o4 4 7 1E1 NOV2 0 4 4.50 M