HomeMy Public PortalAbout6400 ENCINITA AVE_Sewer__ I A. DEP.VWTMENT OF COUNTY ENGINEER
SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION F
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEERI UILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST. -
rf LOCALITYh,. J�) DIIS,TRICT NO�.q SERIAL
QNO.
j-' PERMIT N//0. c
.1 NEAREST / V ' A / O J / T' `f' J
CROSS T. q PTS
,�_ RECE VE BY ReaGY for IneDeotioo DATE ISSUED
OWNER .��/ / ` 7-53
MAIL / USE ZONE OCCUPANCY MAP
ADDRESS_ /,y, _� BK PG
CITY _ �
CONTRACTOR CO.IMP. NO. J 2 7 7—
ADDRESS
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(`C JOB NO. /
CI ,Q TELAO. p TRUNK PERMIT NO.
REGISTRATION NO. Q �p ❑ COUNTY
ROAD PERMIT NO.
LEGAL ,/
DESCRIPTION LOT N0.� .- �.,�J .7/ STATE ENCROACHMENT \
a —>� PERMIT NO.
BLOCK TRACT /jf/1//JT i 'G�f' tASTE APP \ /
WASTE APPROVAL
SIZE OF LOT NOW O BLOGG. /
`^ �d ,Y 16 D NOW ON LOT CHARGES
`Y USE DI '9p&J-_
CONNECTION CHARGE FEE /' \
BUILDINGS //Y
\ NO. DESCRIPTION OF WORK FEE / \
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
a PUBLIC SEWER 0 $ 3.90 RECEIPT NO. /I/ DATE JOY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR `EXCEPTION RECORDED -
WORK TO HOUSE SEWER 1.00
ALTER OR EXISTING -- NO. DATE I BY
SEWER OR DISPOSAL
AL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK, RAI NFI E PIT OR l
PITS AND/OR DRAINFIELD 2.00 _ '. STATION J� .� 0 J 7 DEPTH b
CESSPOOL—DRV WELL
SPECIAL CONDITIONS ONLY 2.00 9 4 MANHPPEflRE=HRENCE 1LOWER
C TVPEO CONNECTION LENGTH FRO
OWNERS PERMIT S 1 00 F.L. M.L.TO P.L.
y� AUTHORIZATION TOTAL FEE U
It
HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE ESCRI BED EXISTING .
DWELLING TO TH PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS... . .......__DAY O ...........19_—_ NEW HOUSE SEWER
OWNER OR _/J' /�,r�,,, CONNECT ADDITIONAL
OWNERS AGENT _. Y�L.r!...'�.::......__ BUILDING OR WORK
'/ .,[ V.......C..•. --�� SEPTIC TANK,SEEP.PIT(S)
ADDflEBS.'`�-_AJ_ ...�L.1--�r. �.- ._..�—.._......_._. ANO/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL I]
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
I HEREBY CERTIFY THAT I 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 DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS El
SEEP.PIT(S)E] CESSPOOLS -�Q 3
SIGNATURE / / � 1�� `._--_.----
OF PERMITTEE. A_....._//_.. �1.� �J
=i 70A642D 663 1/53