HomeMy Public PortalAbout6410 ENCINITA AVE_Sewer__ I I.
g7 DEPAICPMENT OF COUNTY ENGINEER t SEINER—SEWAGE DISPOSAL
I/ 'g-IVISION OF,BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELESUlLD'NG
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WILLIAM J. FOX, COUNTY ENGINEER ,I AOORESS
F R APPLICANT O. ILL IN LOCALITYBUILDING
NEAREST
ADDRESS �a � I�U�-yJ�'�- CROSS ST. QL` Y
LOCALITY �/jl 7 � DISTRICT NO. SERIAL NO. APERMIT NO.
NEARES1CROSS ST. `L/) Y-' �d��S CI.(J AS
�� / RECEIVED BY Ready far Ina Oeetlon DAT�jISSUE { i
OWNEReoF /T% %S e4 /r-< Z L ✓r/
MAIL `U ��• l- ,/�!i�/ USE ZONE OCCUPANCY MA
ADDRESS •fie '<- BK PG
CITY _/ -'(._/_ TELAO. / R— / �s - E '/`1
CONTRACTOR /0741 p�/,� e-e_ /2 77 r
4:-7
CO. NO. G Gr
ADDRESS /q/` &/'
�4 � O 7�i '7 �/ JOB NO.
CITY :� ,# O// 't TEL.NO. _ J/3•f TRUNK PERMIT NO.
/ STATE
REGISTRATION NO. �^/ Q
I , COUNTY- ROAD PERMIT NO
7� / ' G
STATE ENCROACHMENT
DESCRIPTION LOT No �- ,,
PERMiT N0.
BLOCK TRACTS / �� r TL INDUSTRIAL
IASTE APPROVAL
SIZE OF LOTII:NN OF SLOGS.
//) �� NOW ON LOT CHARGES
USE OF
BU ILDINOS ��, CONNECTION CHARGE E
NO. DESCRIPTION OF W K FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING T
PUBLIC SEWER @ E 3.50 b RECEIPT NO. I DATE IBV
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONA L SLOG.OR E CEPTI RECORDED
WORK TO HOUSE SEWE R 1.00
ALTER OR REPAIR EXISTINGHO I ATE
SEWER OR DISPOSAL SYSTEM IAO
DISCONNECT AND ABANDON SEWER . -
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA -
PITSTANK, PIT OR
AND/OR GRAINFIELD 2.00 STATION JJ C! DEPTH
CESSPOOL-DRVWELL -
SPECIALCONDITIONSONLY 2.00 �M HOLE REFERENCE -
SIV WMIOR- ! - LOWER
YPE OF LENGTH FROM
{W •
M.L.TO P.L. '
OWNERS PERMIT $ 1 00
AUTHORIZATION ( TOTAL FEE
1 HAVE.THIS'DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTORmTO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE- PUBLIC SEWER _
SIGNED THIS......1.1.......DAY OF.-.._&?_'___...-.-__.... IPF 2 NEW HOUSE SEWER 5 c./Iroo k-
OWNER OR / CONNECT ADDITIONAL
OWNERS AGENT T '�F�ftn.....�� ..C:.1!Y...... ._ BUILDING OR WORK
............_.._...
SEPTIC TANKSEEP.
ADDRESS..._G% .LB._..1..5'..__E/JF.f.S:L ..'_...._......_.._-....._.._... AND/OR GRAINFIELD IT/S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL I-] DRYWELL�
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 CALIPORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE-DESCRIBED RESIDENTIAL PflOPERTY. BACKFILL SEPTIC TANKS
( SEEP.PIT(S)Q CESSPOOLS 2- ,SG
SIGNATURE1.(�i�-X
OF PER MITTEE..._.._..._.._..4. -_._.. _.._.._.._.....-_.-........_.-..-..
T 6A64EA 663 7/53 (�� K