HomeMy Public PortalAbout6250 ENCINITA AVE_Sewer__ 76A642 -HI APPLICATION FOR PERMIT
TBA8A23 APPLICATION �/
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER __ -
BUILDING AND SAFETY DMSION Bull DING / ,T
JOHN A. LAMBIE. County E. , ADDRESS
ADDRESS
WILLIAM A. JENSEN. Sup'1 of Building_ LOCALITY
NEAREST
FOR APPLICANT TO FH1 IN cgOSS ST.
LEGAL OWNER F
DESCRIPTION LOT NO.
BLOCK TRACT MAIL
�� ADDRESS
NO.OF B GS.
SIZE OF LOT NOW ON LOT CITY TEL. NO
USE OF
BUILDINGS DISTRICTNO GROUP MAP I PROCES ^BY
PIS
CONTRACTOR BK / 21
AILi• D I [J`
ADDRESS 13933 c ' ' CONNECTION DATA
CITY H£ITthornD TEL.N0. STATION , DEPTH
REGISTRATION NO. 193617 C-36 SC -PJ [j COUNTY STATEMANHOLE REFERENCE UPPER
S,
no. DESCRIPTION OF _ FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0600 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE ITS AND/OR DRAINFIE DIT OR IS 39.00 T. CURB P N.L.T P..L.
OVERFLOW SEEPAGE PIT.DRAINFIELD ` T
EATN..CESSPOOL.DRYWELL @ 32.00 Cy
HOUSE SEWER CONNECTING TO P.C.NO. O
PRIVATE DISPOSAL SYSTEM @ $I.00 CO. IMP.NO JOB NO. U
CONNECT ADDITIONAL BLDG.OR TRUNK PEP N0. ROAD PERMIT N0.
WORK TO HOUSE SEWER 0
ALTER.
R REPAIR
SR A SYSTE M H OUSE 0
SEWE@ 3100 STATE ENCROACHMENT G
PERMIT NO.
INDUSTRIAL d
WASTE APPROVAL N
CHARGES Z
WNEWS PERMIT E 2 OO CONNECTION CHARGE FEE
HOMATION TOTAL FEE CID REIMBURSEMENT FEE
E AT DATE A CONTRACT WITH THE HEEICON-
OR TO CION N ECT THE ABOVE DESCRIBED EXISTING ADWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
E PUBLIC SEWER. II i
DAY OF 19_ NEW HOUSE SEWER ,fI
ED THIS _
OR CONNECT ADDITIONAL � I"1/' ` �9 �!�'��✓J
S AGENT BUILDING OR WORK l/
SEPTIC TANK.SEEP.PIT(9) I ' 1
AND/OR DRAINFIELD C
EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
'TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL I] DRYWELL
COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR.SEWER OR
AND SEWERS. SEWAGE DISPOSAL SYSTEM
CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
S REQUIRED LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
OR M THE LEGAL OWNER OF THE ABOVE
iESIDTHAT OPERTY 'f BACKFILL SEPTIC TANKS ❑
SEEP.PIT S ❑ CESSPOOLS
6VALIDATION ROBERT A. WOOD
Oc M.o. WH SUPERVISING MECHANICAL ENGINEER
2230 fJsY ] 10p ^ �
5.0 0
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