HomeMy Public PortalAbout6361 ENCINITA AVE_Sewer__ 76A6420 APPLICATION FOR PERMIT g
58Ee8DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDADOR ING
JOHN A. LAMBIE. COUNTY ENGINEER ESS L/
® OASSATT O. GRIFFIN. SUP T OF BUILDING - LOCALITY
FOR APPLICANT TO FILL IN ceoss sT.
LEGAL /j , OWNER
DESCRIPTION LOT NO, MAIL
f
BLOCK TRACT / /� ADDRESS
NO. OF BLDGS. CITY TEL. N0.
o SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS _
/
L RK PG
CONTRACTOR `� S ,L t—
ADDRESS_5'933 /CONNECTION DATA
s STATION CJ� / f � DEPTH
CITY TEL. NO. ,.,�O MANHOLE REFERENCE UPPE
s9 rATE , Z
REGISTRATI N ���/-2� ❑ COUNTY
NO. 1 DESCRIPTION OF WORK' FEE
HOUSE SEWER CONNECTING TO TYPE OF RB TION LENGTH FROM
_ PUBLIC SEWER @ $3.50 Y.Y' UP.L. M.L.TO.P.L.
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO.
_ EXTN..CESSPOOL,DRYWELL,MAN HOLE @ $2.00 CO. IMP. NO. f p{ 77 JOB NO.
HOUSE SEWER CONNECTING TO OQLI
PRIVATE DISPOSAL SYSTEM @ S1.00 TRUNK PERMIT NO. ROAD PERMI N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT.
t WORK TO HOUSE SEWER @ $ 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNERS PERMIT S 1 00
REIMBURSEMENT FEE '
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN aMED CON APPROVALS GATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THF BOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER) NEW HOUSE SEWER _ JC ✓
SIGNED THIS AY OF 1� CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AG NT SEPTIC TANK,SEEP,PIT(S)
ADDRESS a AND/OR DRAINFIELD
1 HEREBY ACKNOWLED THAT I HAVE READ THIT APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
J PLUMBING AND SEWERS. I SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA PR THAT 0 AM THE LEGA OWN E OF E ABOV
pfi L�IyEdEp -PR RTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S) ❑ CESSPOOLS
OF PERMITT E
JOHN A. LAMBIE.COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
( � so � MAv23 4 4.50 N