HomeMy Public PortalAbout6321 ENCINITA AVE_Sewer__ JBA642GD
APPLICATION FOR PERMIT
5 S G4If-95 '
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL.
Department of County Engineer - . - -' 1 11 -
County of Los Angeles BUILDING
JOHN A. LAMBIE. COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN caogsssr
LEGAL A / OWNER
DESCRIPTION LOT NO. f-�(
MAIL
' BLOCK TRACT 1-2- 115,
ADDRESS
SIZE OF LOT
f04 X / N0. OF
LOT BLDGS. CI TEL. NO.
Sa NOW O
USE OF I
BUILDINDISTRICT NO. GROUP MAP
GS '
�r T ' PG
'CONTRACTOR' .vS/ 1 — '
V
ADDRESS
CONNECTION DATA
� F�
A EL.`N O.( 2 STATION I DEPTH rO
CITY
'O MANHOLE REFERENCFc55i .N6k7�
�A STATE �J LOWER
REGISTRAT1011 NO 'v COUNTY
NO. DE CFHPTION OF� FEE TYPE OF TION LENGTH FROM r1 OF
HOUSE SEWER CONNECTING TO ./ Y_ CURB P.L. M.L.TO P.L. 04.D
PUBLIC SEWER @ S3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @. $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD -7 JOB N0�
EXTN..CESSPOOL,DRYWELL,MAN HOLE @ S E.00 CO. IMP. NO.
HOUSE SEWER CONNECTING TO
�
PRIVATE DISPOSAL SYSTEM $1.00 TRUNK PERMIT N0. gOAD PERMIT NO. `NS
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER (iil $ 1.00 PERMIT NO.
ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM n S 1.00 WASTE APPROVAL'
CHARGES
< CONNECTION CHARGE FEE
OWNER'S PERMIT 1 DO REIMBURSEMENT FEE "
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH T HEREIN NAMED cIN- APPROVALS DATE INSPECTOR'SSIGNATURE
TRACTOR TO CONN"T THE ABOVE OESCR ED EXI ING DWELLING
TO THE PUBLICSE NEW HOUSE SEWER
SIGNED THIS AY OF 19 CONNECT ADDITIONAL
tMtYk@C•-°q2 _ .. R. , BUILDING OR WORK
OWNERS AG T (—,, '«, SEPTIC TANK,SEEP, PIT(S)
ADDRESS
1AND/OR DRAINFIELD
1 HEREBY ACKNO DGE THAT I HAVE READ THS PPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT HE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND(OR G AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE.DISCONNECT PLUG AND
-
CALIFORNIA OR THAT I-AMTHE LEGAL OWNER OF THE ABOVE /I
WER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ Y`/�r �I:
SIGNATURE SEEP. PIT($) L] CESSPOOL
OF PERMITTEE 144 /
JOHN A. LAMBIE. COUNTY ENGINEER VALIDATIO ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. usx - - - -
p4 9 5 APR 1 O.. 4 5.5 D m