HomeMy Public PortalAbout6133 ENCINITA AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BADDRUILDESINSG /13 3 f CiO,
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FLOCALITY
R APPLICANT TO FILL IN
/� ` /1 �• �/gyp//�/ /_�J CROSS ST.NEAREST
./ A a AVC b T�• , DISTRICT N4 SERIAL NO.V PERMITN0.✓� /J.�ij�-i(./] �(.QJLI�1.•( RECEIVED BY Ready for I nspedion DATEISSUED
. ��/ �/ USE ZONE OCCUPANCY BK-MA Q
ADDRESS (e We W&.1.'r PISA,f
CITY / '. e- , TEL.NO:
CONTRACTOR /j/f J¢A.1ld& _ '4:0"o-d eG6C CO.IMP.N0. 7 7 LA-
ADDRESS 3 �r o 0.4 40L/ 4e 4, JDB.NO.
CITY fi??6W»�,e,_ J TTE/L.NO. DQ73111V� TRUNK PERMIT NO.
REGISTRATION NO. �( y��G(� ❑ COUNTY ROAD PERMIT NO. 74' e? 7(j
LEGAL
DESCRIPTION LOT NO. Z t/ 0STATE ENCROACHMENT
- PERMIT NO.
BLOCK TRACT .,7 01{4 INDUSTRIAL
fJ y 'J WASTE APPROVAL
SIZE OF LOT Q Q7</fj' NOW ON LOTS CHARGES
USE
BUILDINGS (7�'1Z)�-a 1.Le,w6.r CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FES
/ HOUSE SEWER CONNECTING TO J
PUBLIC SEWER 0 $ 3.50 J RECEIPT NO. v\ TATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCE TION RECORDED
� . WORK TO HOUSE SEWER IAO Q(1. NO VI
ALTER OR REPAIR EXISTING /I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER \
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR 200PITS AND/OR D E . �STATION / LTDEPTH
MANHOREFERENCECESSPOOL-DRYWELL 2TCR
Q
LOWERSPECIAL CONDITIONS ONLY TYPE
OF CONNECTION LENGTH FROM `
OWNERS PERMIT 1 �7 O
S I Y CURB t� M.L.TO P.Ly
AUTHORIZATION I TOTAL FEE 4'
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS..-J.......DAY OF.__��_----------193Y NEW HOUSE SEWER
�dJ". Gif.(/Y
CONNECT ADDITIONAL -
OWNER OR • BUILDING OR WORK
OWNERS AGENT.. � _
...._....)._......_Y- ..�•_`. .�...,.,_,r.._.. ....._.._..._ SEPTIC TANK,SEEP.PIT(S)
ADDRESS.__.../.�1_ 7. ..._P._F.'.�*!�..-!'� -.-'--.._-. AND/OR DRAT NFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL Q DRYWELL E]
CATION 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HO PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)[3 CESSPOOLS E]
.��� � _ isV�E.F� ,
OF PERMITTEE.
76A64EA 663 7/53