HomeMy Public PortalAbout6222 ENCINITA AVE_Sewer__ &> 6 1
.
E. APPLICATION FOR PERMIT
6DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL .
Department of County Engineer - -
County of Los Angeles emLmNG
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
® CASSATT 0. GRIFFIN. SUPT of BUILDING LOCALITY
NEAREST
FOR PPLICA T T ILL I_ N _ CRASS ST.
LEGAL 1 Bbl W��
DESCRIPTION JON LOT NO. OWNER
MAIL
BLOCK /, TRACTi - p DRESS
'•? NO.OF BLDGS. 1
S12E OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR /7-
CONNECTION
CONNECTION DATA
ADDRESS
STATION Z�1'15<� DEPTH !
CITY TEL. N0. G
MANHOLE REFERENCE UPPER
STATE
REGISTRATIO N0. /�i n L/ ❑ COUNTY j
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO _ TYPE OF Cjyyl(JiCTION LENGTH FROM
Y. RB`l P.L. M.L. TO P.L.
PUBLIC SEWER @ S 3.50
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q S 3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD r� /f P. C. NO,
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $ 2.00 CO. IMP. NO. j '—! 108 N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q E'I.00 TRUNK PERMIT N0. ROAD PERMIT NO.!?/
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $ 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE � L
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
HAVE
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
-. OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS ANO/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL[I{ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING k 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 REOUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR TH 1 AM T E EG L OWNER OF THE ABOVE /.tyP
f DESCRIBED RESIDE IA PROP T. T BACKFILL SEPTIC CTA ❑
SIGNATURE SEEP. PITS) ❑ CESSPOOL
OF PERMITTEE
JOHN A. LAMBIE. COUNT NGINEER VALIDATION ROBERT A. WOOD. CHIEF PLBG. INSPECTOR
CK. M. 0. GsvH
M�s.11 f ED 3 4 8 9 OCT 1 8 4 4 5 0 2