HomeMy Public PortalAbout6168 ENCINITA AVE_Sewer__ n° BAB
APPLICATION FOR PERMIT.
EPARTbIENT
F LOS ANGELES 6a-o y� SEWER-SEWAGE DISPOSAL OF COUNTY ENGINEER• °_a/I''Q0, - - -
BUILDING AND SAFETY DIVISION -• II BUILDING
` ADDRESS
iOHN A. LAMBIE.GRIFFI , untSupyt .1 gineerBad
C SATT D. GRIFFIN, Supt o1 Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN ceo$S ST.
LEGAL
OWNER
DESCRIPTION LOT N0.
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF _ ..
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
t CONTRACTOR I BK /IPG
ADDRESS '— CONNECTION DATA
CITY L.NO. ' STATION DEPTH
REGISTRATION N0. STATE UPPER
xo. DESCRIPTION 0
/ ->'(-:��21 �� LOWER
FORK FE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00
SEPTIC TANK.SEEPAGE PIT OR r
TYPE OF CONNECTION LENGTH F
Y. CORE P.L. M.L.TO
PITS AND/DR ORAINFIELO 9 $5.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN-.CESSPOOL.DRYW ELL @ 82.00
HOUSE SEWER CONNECTING TO CO. I N0. JOB NO.
P.C. .
_ PRIVATE DISPOSAL SYSTEM @ $t.00 MP.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00 )
ALTER.REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $'-Do PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PEAMIT $ Z 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEEI HAVE MAOOL// � lC
bS
TRACTOR p TO THIS
ONNECT THE ABOVE DEISCRIBED EXIISTTH THE IINGADWELUNG APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEW Rry
SIGNED THIS ,jt__DAY OF 19,b.Q nEw xOUSESEWER
OWNER OR OWNERS AGENT J CONNECT ADDITIONAL /p,/ ®•
ABUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
PLUMBING AND SEWERS. ALTER.REPAIR.
SEWERDISPOSAL OR
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR a SEWAGE DISCONNECT PLUG AND
r EM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCABANDONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF TyE ROVE
DESCRIBED RESIDENTI ROPERT ` / . BACKFILL SEPTIC TANKS ❑
u SEEP. PIT(S) ❑ CESSPOOLS ❑
SIGNATURE
OF PERMITTE
® VALIDATION) ROBERT A. WOOD
CK. 9.0. CASH SUPERVISING MECHANICAL ENGINEER
LACO 9 3 9 2 2 APR 1 g 1 0 A 3.0 0 2