HomeMy Public PortalAbout4903 MCCLINTOCK AVE_Sewer__ TEMPLE CITY.
BABd2D APPLICATION FOR PERMIT
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COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING 77777
ADDRESS
JOHN A. LAMBIE, County Engineer
CASSATT D. GRIFFIN, Supt of Building LOCALITY
NEAREST -- - _
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL —�"-- ---'—'
DESCRIPTION LOT NO. OWNER
BLOCK :: TRACT r' MAILell
f - ADDRESS J_
ND.OF BLDGS.' - z
SIZE OF LOT NOW ON LOT CITY(_ 47 t TEL.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY;,
BK PG i
CONTRACTOR.` -- -- - --- �- f
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ADDRESS CONIIECTION DATAt— J
CITY 'sI-1.,N0. 5'f'A'YION DEPTH f.
J
❑ STATE MANHOLE REFERENCE - - +1- PPrR,..
REGISTRATLO_N NO _ _ _ ❑ COUNTX
No. DESCRIPTION OF WORK FEE - p -
HOUSE SEWER CONNECTING TO -
PUBLIC SEWER @ $3,00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. I `
PITS AND/OR DRAINFIELD @ S3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00 -
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM $1,00 CO.IMP. NO. `. � JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUN'-PERMIT NO. ROAD PERMIT NO C/' > �'
WORK TO HOUSE SEWER @ $1.00
ALTER,RE:pA1R OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT -- CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT DATE A CONTRACT WITH THE CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTIINGAMED DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER, v -
SIGNED THIS DAYsF 19� NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑.
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 DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM TH,E LEGAL OWNER OF THE ABOVE BACKFILL SEPTIC TANKS ❑
DESCRIBED RESIDENTIWt,FROPERTYr SEEP,PLL SE ❑ CESSPOOLS ❑
SIGNATURE r�r•:-,� ✓ L A".✓ y ., r o;
OF PERMITTEEr `) " / �,,
6-
N - VALIDATION ROBERT A. WOOD
s X.p. c"If SUPERVISING MECHANICAL.ENGINEER
EEo8243.59 APPLICATION FOR PERMIT "Il �.
COUNTY OF LOS ANGELES SEWER-SEWAGE°'DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION nnn�E sG 4 �+�CC'�.1 T] OC
JOHN A. LAMBIE, County Engsneer � ��P�e
CASSATT D. GRIFFIN, Sup t of Building LOCALITY s
NEAREST
FOR APPLICANT TO FILL IN CROSS ST-4 . {
LEGAL { GuyE. �lO:L't'<� ock
DESCRIPTION LOT NO. OWNER
BLOCK TRACT / �? MAIL `C s a a PL a
ADDRES§C,' y
NO OF BLED 1-3154
SIZE OF LOT N2W;�ON LOT
CITY TEL. N0. -
USE OF
BUlLDENG5 DISTRICT N0. GROUP MAP PROCESSED BY
7�t FFBK PG
CONTRACTOR L. D. d`A'1
' .^ i-t'Cons es . Co. '" _,�- ;_z 'y:-. �•y ;y
Lb
ADDRESS 5136 No.. C. C?T - CONNECTION DATA
CIT a _k. TEL N0. ` S PION a - (rt', ;d DEPTH /
STATE PER
(' i ice, MANHOL R1=FERENCE ,
REGISTRATION NO. w < - - 8{3L+fi'"TY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH,FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. .14.L,TO P.L.
ITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD '.
EXTN.. CESSPOOL.DRYWELL @ $2.00 -E- C-
HOUSE SEWER CONNECTING TOP.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1..00 _ CO. IMP. yo, / JOB NO.
CONNECT ADDITIONAL BLDGPERMIT NO
.OR TRUNK PERMIT NO. ROAD-
WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @b $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT 3 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE I REIMBURSEMENT FEE
I HAVE AT THIS. DATE A CONTRACT-WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER,
SIGNED THIS -DTAY OF 19_ NEW HOUSE SEWER
OWNER OROWNERS AGENT NEW CONNECT ADDITIONAL i
BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PITS)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL Q DRYWELL Q {
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRCI) BY COS ANtELES -COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR s.H''i'< t AM-T.%-",I�GG� pWI}IER,'p�F THE ABOVE. ABANDON HOUSE SEWER
DESCRIBED RESIDIALI'PR"OPERTY. y ""'�-'--r:''�- BACKFILL SEPTIC TANKS ❑
SIGNATURE f ,�'L SEEE'.PIT{S} ❑ CESSPOOLS
OF PERMITTEE
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?A Z:YALIDATION ROBERT A. WOOD
Clyf H.o. CASH SUPERVISING MECPIANICAL ENGINEER
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