HomeMy Public PortalAbout6235 ENCINITA AVE_Sewer__ CE808
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7GA84 APPLICATION FOR PERMIT
TBA
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION [A..RE..DING / 1 '.
JOHN A. LAMBIE. Counly Engineer 0 Z
WILLIAM A. JENSEN, Supt o2 Building
ALITY
REST
FOR APPLICANT TO FML IN SS ST.
'LEGAL
DESCRIPTION LOT NO. ER /
qJy^/� �J _
BLOCK TRACT�.J / v RE55NO. OFBLDGS.S12E OF LOT NOWON LOT �Q{PA TEL.
USE OF
BUILDINGS OISTRICi.NO. GROUP MAP PROLE'FD BY
CONTRALTO o �-
L.
ADDRESS� fir' Jt 'ts�� �/ , q�._.!/ CONNECTION DATA
DEPTH
p�
/ '/ - 2— vK _'ATE MANHOLE REFERENCE
REGISTRATION NO. ^� LJ COUNTY
NO. DESCRIPTION OF WORK FEE TYP O NECTION NGTH FROM d
HOUSE SEWER CONNECTING TO v^ T. B p.L. .L TO P.L. 10 O
PUBLIC SEWER a 53.00 CJ
P.C.NO. V
SEPTIC TANK,SEEPAGE PIT OR
PIT$AND/OR DRAINFIELD 310.00 CO.IMP. NJOB NO.
O
HOUSE SEWER CONNECTING TO
TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM Qp 59.00
CONNECT ADDITIONAL B LDG.ON AFFIDAVIT=NT RECORD.INSTR.NO. GATE W
WORK TO HOUSE SEWER 53.00 d
OVERFLOW SEEPAGE PIT,DRAINFIELD to
E%TN.,CESSPOOL,ORYWELL,MAN HOLES $5.00 Z
ALTER.REPAIR OR ABANDON HOUSE HW T.OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCRO CHME[
PERMIT N .
NDUSTRI L
WASTE APPROVAL
CHARGES
OWNERS PERMIT a i 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITFJ HE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRI ED E%ISTING OW FEEING
TO THE PUBLIC SEWyRr.� .✓ /'/ APPROVALS PATE INSPECTOR'S SIGNATURE
SIGNED THIS /V DAY OF /�-�e� Ilew yi 1.
OWNER Oft NEW HOUSE SEWER
OWNERS AD. E"✓:-rJ
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP,PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED NO/OR
ALTER,REPAIR.SEWER OR
LICENSED AS REQUIRE BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT AM 'H�E LEGAL OWN ER OF. AND INTEND TO DISCONNECT PLUG AND
RE510E IN. THE AB cN L PROPETY.
WW-��!! Y ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE ❑
SEEP.PIT(S) ❑ CESSPOOLS
VALIDATION ROBERT A. WOOD
CK. M.0. . SUPERVISING MECHANICAL ENGINEER
u+�o 4 4 6 7- JAN 15 1 0 D 7.0 0"
CE808 10-52 APPLICATION FOR PERMI
TOA642D
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION eu aDlNc q / '
JOHN A. LAMBIE. County Engineer
WILLIAM A. JENSEN. Supt of Building LDcnuiY L
NEAREST
FOR APPLICANT TO FILL IN CR055 BT. �
LEGAL
DESCRIPTION LOT NO.� OWNER
MAIL
BLOCK TRACT
AD DflE55 G /d�
SI2E OF LOT NOW OON LOT B CITY /<.•C•, TEL. .0,,f2 n�
USE OF
BUILDINGS DISTRICT440.10ROUP
BK MAP
1iA1
PROC S
SED BY
r
CONTRACTOR /PG
EONNECTION ATAADDRY [C TEL. NO. . TGN � / DEPTH
e,:5
REGISTRATION NO. �JO/ 7' [STATE MANHOLE REFERENC }
/ L❑J COUNTY � ER 6
NO. DESCRIPTION OF WORK FEE iYP O �{NECT IO / LEN H FROM O
HOUSE SEWER CONNECTING TO CI},A P"L. M.L TO P.L. , U
PV ELIC SEWER ® SS.00 J�f P.C.NO.
/ y.
SEPTIC TANK.SEEPAGE PIT OR GO.IMP.NO. ` � JOB NO. O
PITS ANO/OR GRAINFIELD SIO,00 I�
HO US ESEWERC ONNECTINGTO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIV ATE DISPOSAL SYSTEM ® $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT=RECORD.INSTR.No I DATE a
y
WORK TO HOUSE SEWER 33.00
OVERFLOW SEEPAGE PIT.GRAINFIELD
EXTN.,CESSPOOL,DRYWEL L,MANH OLEO 85.00
ALTER,REPAIR OR ABA14DON HOUSE HWY.OR ST.WIDENING
S9W&RQR O SPO ALAI EM $3.00 STATE ENCROACHMENT
PERMIT No.
IN°USTRIAL
WASTE APPROV �(/)
CHARGES
OWNERS PERMIT S
AUTHORIZATION I TOTAL FEE `, CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
To
THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR - NEW HOUSE SEWER
OWNERS AGENT
CONNECTADDITIONAL
ADDRESS BV ILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATI DN AND/OR GRAINFIELD
ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENBE° AS REQUIRE �j.ANGLES COUrvTY ANO STATE OF SEWAGE°ISPOSAL SYSTEM
CALIFORNIA OR THAT GAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE ABO DD RESIDENTIAL P PERTY.
ABANDON HOUSE SEWER
SIGNATURE e BACKFILL SEPTIC TANKS ❑
OF PERMITTEE ❑
SEEP,PIT(B) ❑ CESSPOOLS
l I
VALIDATION ROBERT A. WOOD
K. M.O. CASH
SUPERVISING MECHANICAL ENGINEER
C
L&4468 JAN 1511 D 2 5.0 0