HomeMy Public PortalAbout6351 ENCINITA AVE_Sewer__ D APPLICATION'.
PERMIT
6.K-6 �-
G 6.2D 1254
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING A
WM. J. FOX, COUNTY ENGINEER ADDRESS e
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY OAJ Ole ,�/
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL
DESCRIPTION LOT NO. .9 p < OWNER ✓: - �' C /
BLOCK TRACT '2 / S ADDRESSJ ALT A
SIZE OF LOT ~AA J� N0. OF SLOGS.
NOW ON LOT CITY �(> TEL. NO.
USE OF ` �' ' /
BUILDINGS )I,��/� $A/ zt p 'lC�ri/rtl�01I OI BTRIC.T�I ROUP MAP
CONTRACTOR �J (� ^T BSG
ADDRESS —j`/�/ry% •✓ CONNECTION DATA /
CITY �� ,TEL. NO. STATIONEl4 f- �_y DEPTN �, A
❑ STATE A-.t..G / S OMAN REFERENCE
REGISTRATION NO. COUNTY UPPER
/r/ f�
N0. DESCRIPTION OF WORK FEE TYPEO N CTION LENGTH FROM
Y. URB P.L. M.L.TO P.L.
/ HOUSE SEWER CONNECTING TO —3 6fl
_ PUBLIC SEWER Q $ 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ROBLDG. OR -- CO. IMP. N0. JOB. NO. J{
WORK C HOUSEUSE SEWS SEWER 1.00
\\
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 __ TRUNK PERMIT NO. ROAD PERMIT NO. 4 , 71
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT /
_
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
OWNERS PERMIT
CONNECTION CHARGE FEE
5 1 00
AUTHORIZATIONTOTAL FEE i� REIMBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED COON.
HAVE
TO CONNECT THE ABOVE ESCRISED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC ER (�
SIGNED THIS DAY OF 79; NEW HOUSE SEWER -7 SS /Jad ra)rflJp�Q
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
} SEPTIC TANK, SEEP. PIT(S)
ADDRESS 0 'AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAW'S REGULATING ALTER. REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY 3-151.— ANO/OR
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. -BACKFILL SEPTIC TANK$'3
l sEEP. PIT l57 ❑ CESSPOOLS J� -TSS ("iTd MAAPf.�l.t%
SIGNATURE /
OFPERMITTEEL J• I
WILLIAM J. FOX, COON- Y ENGINEER VALIDATION
�5 0 8`5- X27 4 4.50 in
BY BY
DEPUTYDEPUTY
41F
BY BY
0 DEPUTY ' DEPUTY