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Home My Public Portal About6237 ENCINITA AVE_Sewer__ CESOO D7GA64 IO-°= APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION - BUILDING '7 ry JOHN A. LAMBIE, County Engineer ADORESs G WILLIAM A. JENSEN. Sup't of Building _ LOCALITY NEAREST FOR APPLICANT TO FILL IN CROES 5T. LEGAL J R.PT. / LOT NO. �(r OWNER MAIL BLOCK 4: L / TRAACT/ q g�O yp ADDRESS /�y/y� //{`.C��/ 512E OF LOT G 'A ��/ NbW ON LOTS /O CITY / / "r TEL. NQ/'� Cl�yb�7 VSE OF DISTRICT NO. GROUP MAP PROCESSED BY BUILDINGS �• V'/� �Iry J� BK PG CONTRACTOR go ,r � / ADDREss S O 1� C '� CONNECTION DATA TEL. NO. /f.� STATION DEPTH (/ V �✓ STATEUPPER REGISTRATION NO. 8 COUNTY MANHOLE REFERENCE LOWER a NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM O HOUSE SEWER CONNECTING TO Y. CVRB P.L. M.L.TO P.L. V PUBLIC SEWER @ 55.00 SEPTIC TANK.SEEPAGE PIT OR P.0 NO. IY PITS AND/OR GRAINFIELD a $,O.00 CO.IMP.NO. JOB NO. rO HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. UJ PRIVATE DISPOSAL SYSTEM ® 53.00 IIIYYY CONNECT ADDITIONAL SLOG.OR AFFIDAVIT AIY SIR[Ki RECORD.INSTR.NO. DATE d WORK TO HOUSE SEWER ® 53.00 N OVERFLOW SEEPAGE PIT,GRAINFIELD EXTN..CESSPOOL.ORYWELL.MANHOLE @ $3.00 i ABANDON HOUSE /_-�/1 HWT. OR ST.WIDENING _ ' DISPOSAL SYSTEM $3.00 V STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERSI PERMIT sl z 00 CHARGES AUTHORIZATIONTOTAL FEE -0 CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBEQAxETING DWELLING TO THE PUBLIC SEWS APPROVALS DATE INSPECTOR5 SIGNATURE SIGNED THIS S OWNER OR NEW HOUSE SEWER OWNERS AGENT / CONNECT ADDITIONAL AODREBS C. BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAT NFIELD ANO STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT I AM P PERLY REGISTERED ANO/Ofl ALTER. REPAIR.SEWER OR LICENSED AS REQUIRED BY L NG ES COUNTY AND E F SEWAGE DISPOSAL SYSTEM n CALIFORNIA OR THAT qM E L NER OF, AN N RESIDE IN. THE ABOVE /R DENTI P TY. - DISCONNECT PLUG AND ABANDON HOUSE SEWER J IGNAT URE L-: PERMITTEE SEEP.FILL SEPTIC TANKS P T(S) El C SSP.00LS'lgl CK. 0 M.0. GBM VALMATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER lrl01053G OUT 71 0 0 8.00- oat, .00-oat/ � . ' 6A641°'B2 720 APPLICATION FOR PERMIT BA84 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER _ BUILDING AND SAFETY DIVISION BUILgi? — - OHN A. LAMBIE, County Engineor ADDRWILLIAM A. JENSEN. Supt of BuildingLOCANEARFOR APPLICANT TO FILL IN CROS LEGAL DESCRIPTION LOT NO. A [a� OWNER �$ l MAIL IV BLOCK` / TRACT d T ADDRESS {{{ NO. OF SLOGS, SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF DISTRICT NO, GRO MAP PROCESSED BT BUILDINGS PG / BK CONTRACTOR A `V ADDRESS 4r _ � CONNECTION DATA �I ` / STATION q/u ` DEPTH CITY TEL. NOt.J3.1 f- psTATEMANHOLE REFERENCE �!,/� } REGISTRATION NO. ❑ COUNTY � / LOWE d NO. DESCRIPTION OF WORK FEE TYPE OFC TION LENGTH FRO O HOUSE SEWER CONNECTING TO L,/I� T. CIPri P.L. M.L.TO P.L. V PUBLIC SEWER ® 53.00 OR PC NO SEPTIC TANK.SEEPAGE PIT PITS AND/OR GRAINFIELD @ SI0.00 CO.IMP. NO. UOB NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM ® $3.00 LLLLLLIII CONNECT ADDITIONAL BLDG.OR AFFIDAVIT A'VpI u5[x[NT RECORD.INSTR,NO. DATE a WORK TO HOUSE SEWS R 0 $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD Z EXTN.,CESSPOOL,DRYWELL.MANHOLES3.00 ALTER.REPAIR OR ABANDON HOUSE NWT.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM S3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s z 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I 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 INSPEC O SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR - NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL / ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP, PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL ❑ IHEREBY CERTIFY' THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A E ESC. BE E.H. IAL PR PERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD cK. M.G. CASH SUPERVISING MECHANICAL ENGINEER AC01 2 3 1 E OCT 9 1 0 0 7.0 0, v