HomeMy Public PortalAbout6160 ENCINITA AVE_Sewer__ '1eA .
965 APPLICATION FdR PERMITSeDIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer'
County of Los Angeles - BUILDING`
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
® CASBATT D. GRIFFIN, Suai OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL S' /� _ �3 ^ OWNER ` y
DESCRIPTION LOT N0 - .l ! T
BLOCK TRACT�..._�/s ? ADO R ESS
NO. OF SLOGS. d CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF - "
BUILDINGS it DISTRICT NO. GROUP MAP FG
CONTRACTOR O Ct BK
y
' aooREss CONNECTION DATA Lam/
STATION DEPTH
CITY ' wr TEL. NO.
MANHOLE REFERENCE UPPER .
LOWER
REGISTRATION NO. /�� ��� U Q COUNTY � " 41-
rvo. DESCRIPTION OF WORTTT FEE (!
HOUSE SEWER CONNECTING TO TYPE OF CONINJ LENG H FROM
PUBLIC SEWER @ $3.50 Y. CURB P.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD C4 $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD P. C. NO.
EXTN..CESSPOOL.DRYWELL,MANHOLE n $ 2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO .
PRIVATE DISPOSAL SYSTEM (n1 S I.00 TRUNK PERMIT NO. ROAD PERMIT NO,
CONNECT ADDITIONAL BLDG.OR STATE ENCROAC ENT
WORK TO HOUSE SEWER @ $1.00 PERMIT N0.
,�. ALTER,REPAIR OR ABANDON HOUSE '. INDUSTRIAL
SEWER OR DISPOSAL SYSTEM n $ L00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT E 00
AUTHORIZATION TOTAL FEE 00 REIMBURSEMENT FEE /Ph
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'SSIGNATURE
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 " L�
OWNERS AGENT SEPTIC TANK,SEEP. PIT(S)
ADDRESS AND/OR DRAINFIELD _
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION 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 I AM PROPERLY REGISTERED AND/OP DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON CT PLUGHOUSE AND
CALIFORNIA OR THAT I AM THE .LEGAL WIN THE ABOVE
-
DESCRIBED RESIDENTIAL PROP T BACKFILL SEPTIC TANKS El
SIGNATURE I SEEP. PIT(5) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE. COUNTY EN NEE IDATION ROBERT A. WOOD. CHIEF PLBG, INSPECTOR
CH. N.0. CASH - - - - -
N
U�Co 1 4 2 3 2 EY 27 10 G 3.0 0