HomeMy Public PortalAbout6245 ENCINITA AVE_Sewer__ 76A642 -BI APPLICATION FOR PERMIT {�
CE808 3 u
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISIONBUILDING
JOHN A' LAMBIE. County Enggi�nneer ADDRESS
WILLIAM A. JEHSEN. SYp'1 0l Building LOCALITY
FOR APPLICANT TO FILL IN
lll"E[CROSS 9T. ,
LEGAL L L
DESCRIPTION LOT N0. OWNER L —
� MAIL //
BLOCK TRACT (JLC ADDRESS6 3 L//A// T
�J ( NO.OF BLDGS. ^
SIZE OF LOTppO O Jqq NOW ON LOT /� CTT /' TEL. NO
BUELDI yOF .VCyI iP� G DISTRICT NQ. GROUP BE
MAP PO PRJJOCESS�Y
CONTRACTOR Alert Harating XUJ -T- /e7 — / �
ADDRESS 13933 So. Crenshaw CONNECTION DATA
cITY Hawthorne TEL.NO.0 S 9 3691 STATION DEPTH
REGISTRATIONNO. 193617 SC-42STATE MANHOLE REFERENCE UPPER
COUNTY LOWER
NO. DESCRIPTION OF WORK FEE -
HOUSESEWERCONNECTINGTO /
PUBLIC SEWER @ 33.00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD Z 2 1
EXTN..CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO P.C.N0. O
PRIVATE DISPOSAL SYSTEM @ $1.00 y� CO.INP. NO. JOB NO. �' U
WORK TO HOUSEISEWEBLDG.OR $1.00 C/ TRUNK PERMIT NO. I L ROAD PERMIT NO. D=
ALTER,REPAIR OR ABANDON HOUSE PSTATE ENC
ERMIT NOpOACHMENT 1 J/ Z.
SEW ER OR DI SPOSAL SYSTE @ $
1,00 /II F CJ
INDUSTRIAL oo j W
WASTE APPROVAL
���tcoNERQHARGES i ?
�I. OTT �.S PERMTI $ 2 00 CONNECTION CHARGE E�
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE Y
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN WANE
D CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROV DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. !/
SIGNED THIS DAY OF 19— NEW HOUSE SEWER
OWNER OR -CONNECT ADDITIONAL �iJ. ./J
OWNERS AGENT BUILDING OR WORK N'" ;
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL 0 DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER.REPAIR.SEWER OR
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AHD/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PR OPE TY BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS
OF PERMITTE
/�AL ROBERT WOOD
B..O.0. CASH SUPERVISING MECHANICAL ENGINEER
1Af08 1 9 3 % FEB 91 0 D 3.0 0 n
D
76A642 -61D APPLICATION FOR PERMIT . . �,?�`
CE808
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION BUILDING 6 i ��
JOHN A, LAMBNi. County Evginner ADDRESS
WILLIAM A. IENSENr Supt oI Building LOCALITY
NEAREST /O
FOR APPLICANT TO FILL IN cRoss sr.' !� i✓OW
LEGAL /�
DESCRIPTION LOT N0. ISG OWNER 1} L.Te R (,J el..
BLOCK TRACT NAIL
Q ADDRESS
N0.OF BLDGS.
SIZE OF LOT O ,.S NOW ON LOT CITY TEL. NO
USE OF
BUILDINGS � r �DISTRICT N0. GROUP P6 YAP PROC ED Y
(`/
CONTRACTOR 6T 0 I{
BK
ADDRESS 1. V 33933 So. Cpanshq IV 21,'d CONNECTION DIATA
CITY lin TEL.NO. STATION D DEPTH
STATE
REGISTRATION NO. TT COUNTY MANHOLE REFERENCEUP
i
NO.. DESCRIPTION FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ .00 TYPE OF CONNECTION LENGTH F0.0tl
SEPTIC TANK.SEEPAGE PIT OR T. CURB P.L. N.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD }
EXT N..CESSPOOL.DRYWELL @ 52.00C.
d
PRIVATE DISPOSAL SYSTEM TO @ $1.00 CO.IMP. NO. JOB NDO O
U
CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
A LTER, @ REPAIR OR ABANDON HOUSE STATE ENCROACNNENT v
SEWER OR DISPOSAL SYSTEM $1.00 PERMIT NO.
INDUSTRIAL 1
WASTE APPROVAL to
CHARGES Z
OWNERS PEBMIT f p QQ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN f MED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS I DKTE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 9— NEW HOUSE SEWER
OWNER OR ,j� CONNECT ADDITIONAL
OWNERS AGENT �` CONNECT
OR WORK
ADDRESS SEPTIC TANK.SEEP.PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS. CORRECT AND AGREE TO COMPLY CESSPOOL b DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER.REPAIR,SEWER 00.
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY TH T 1 AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED B LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT M THE LEGAL 0 F THE ABOVE ABANDON
SEPTIC TANKS ❑
DESCRIBED RESID OPERTY. SEEDA CP.PITS ❑ CESSPOOLS
SIGNATURE ��{f/'
OF PERMITTE
VALIDATION ROBERT A. WOOD l
CL a.0. WN SUPERVISING MECHANICAL ENGINEER
LA_01 4 9 8 APR 2 3 1 0 0 7 0 0