HomeMy Public PortalAbout6155 ENCINITA AVE_Sewer__ 6 E
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95 .6APPLICATION FOR PERMIT
DIViSION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Dupautuent of County Engineer - — - �
County of Los Angeles BUILDINGADDADDRESS .. `� � .'�.� ��• /it-e-l.�Y�r-T r !t/
JOHN A. LAMBIE. COUNTY ENGINEER ,qL
® CASSATT D. GRIFFIN. SUP T OF BUILDING LOCALITY
' FOR APPLICANT TO FILL IN
MEANEST
eOsS ST. G�G[. li�iu✓I f>�
LEGAL (J
DESCRIPTION LOT NO. 9
2 �+7 OWNER
I .fin �C�} (j�iVV�•'
MAIL
BLOCK TRACT s-9 41 ADDRESS 4 /❑ / T3 +!� •p,r. t ! 1J /y
SIZE OF LOT _ f O.OF SLOGS. CITY , TEL. N0. �,����.
NOW ON LOT
USE OF
BUILDINGS � .x_-a.-G�".� DISTRICT NO. GTOUP MAP
` BK PG
CONTRACTOR S .ice ��7
ADDRESS L j '7) ,,r`� CONNECTION DATA
CITY .a f, , TEL. NO. v {I/ STATION DEPTH //
MANHOLE REFERENCE UPPEH
❑ STATE PAVER
REGISTRATION N0. ❑ COUNTY 1'NO. DESCRIPTION OF WORK FEE
TYPE OF CONNECTI01 LENGTH FRO
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L. TO P. .
PUBLIC SEWER @ $3.50
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR GRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT.GRAINFIELD CO. IMP. NO. /1 B
EXTN.,CESSPOOL.DRYWELL,MAN HOLE @ $2.00 10.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR - STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $ 1.00 1/ PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @_$1.00 - WASTE APPROVAL '
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT s 1 00
AUTHORIZATION TOTAL FEE tL EIMBURSEMENT FEE Y
y 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE$EWER [l. LY/
SIGNED THIS DAY OF 19_ ' CONNECT ADDITIONAL
OWNER OR yJ I't� `J� I �Vt�„_.I/ BUILDING OR WORK
OWNERS AGENT / wKs SEPTIC TANK,SEEP,PIT(S)
AGGRESS AND/OR GRAINFIELD
I
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE-TO COMPLY
t WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR = DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE Y -1� ./� �/J1 SEEP. PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE R ���= *�• �✓Z^ -«��
JOHN A. LAMBIE. COUNTVVJENGINEER 9 VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. W.0. CASH
iLACCO 17 :• 0�9 JAN 10 4 2.0 0