HomeMy Public PortalAbout6246 ENCINITA AVE_Sewer__ /< i / G /s dr
DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING Il
` ADDRESS &2ZI4 /Y. f0i 41 Ale
FOR
�APPLICANT
TO FILL IN LOCALITYBUILDING
Tm.rNEAREST -/,� � (/
[OWNER
DDRESS /✓ ' / CROSS ST. �O/)UCJj�n d "r1a e /'il IT '
OCALITY �� Oil DISTRICT NO. SERIAL NO. PERMIT N0.
EAREST ,/) A 73G y /779 S
ROSS ST.
RECEIVED By Randy for Inaoecticn GATE ISSUED
MAIL
ADO REfiS USEZONE OCCUPANCY MAP
3L
BK PG
CITY TEL.NO.
CONTRACTOR 45�
I<77- /BO.IMP.NO. LADDRESS 17OB.NO.
RUNK PERMIT NO.
REGISTRA710NN0. ❑ S /CROAD PERMIT NO. 2.37267
LEGAL �-.r� p _ STATE ENCROACHMENT
DESCRIPTION LOT N0. �/ V IY�V PERMIT NO.
BLOCK /- TRACT R j /�i INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT �6 d p OBD {'
NONOW ONFL
LOTGS. / CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION DF WORK FEE .��
REIMBURSEMENT FEE
NOOSE SEWER CONNECTING TO
l PUBLIC SEWER Q $ 3.50 JQ RECEIPT NO. I DATE _ IBY
HOUSE SEWER CONNECTING TO -'
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 No--I DATE _ 113Y
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM I.00 ----
DORPOSASN SEWERANRDISL TEM1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR GRAINFIELD 2.00 I STATION 7122, D DEPTH - /
CESSPOOL-DRYWELL
SPECIAL CO NDITIO NS ONLY 2.00 /3/ � r,A-{ ANUPPER EFEREN CE LOWER
TYPE.OF CONNECTION LENGTH FROM
V. ✓ CURB —P.L. —M.L.TO P.L. J 7
OWNERS PERMIT $ I 1 00
AUTHORIZATION I TOTAL FEE 41 5Z
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS...................DAY OR. 19....... NEW HOUSE SEWER
OWNER OR /1 �n(�, BUIL4DING ORD
DWORKAL
OWNERS AGENT......_.._.._.._........_..._..._..
SEPTIC TANK.SEEP.PIT(S)
ADDRESS... ........................._..__...._......._................_......._ AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL❑
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE OE RIeED RESIDENTIAL PROPERTY. - BACKFILL SEPTIC TANKS
SIGNATURE / ' SEEP.PIT(S)Q CESSPOOLS❑
OF PERMITTEE._ ._ ..__._ CJ..QYL/... .-. ,'@5[.`-
7GA642D 663 1/53