HomeMy Public PortalAbout4907 MCCLINTOCK AVE_Sewer__ L
X8aaFOAS4z8.59 APPLICATION- FOR PERMIT
COUNTY OF LOS ANGELES SEWER-S'kWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ADDRESSG911lttt 0t+ 713OC
JOHN A. LAMBIE. County Engineer
CASSATT D. GRIFFIN. Supt of Building LOCALITX `
NEAREST
FOR APPLICANT To FILL IN CROSS ST..
DESCRIPTIONLEGAL
EL
LOT NO. OWNER GUY 211oreloc-'
BLOCK TRACT MAIL21035 : e s a Eica F
ADDRE
NO.OF BLDGS. 2 t-5
5
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS , ` ` DISTRICT N0. GROUP MAP PROCESSED B,,>
BK PG
CONTRACTOR • , OT1 T w I /v
ADDRESS b 5l3 t7. e@C Oma' CONNECTION DATA
CITY EL.NO. ,U X'allJ ` STATION f `f fl DEPTH y
i
STATE MANHOLE REFERENCE Y
REGISTRATION N0. ! 7: - �� __COgfyiTY LOWER',`
NO. DESCRIPT ON OF WMK FETE
r HOUSE SEWER CONNECTING TO -
PUBLIC SEWER @ $3.00 -D TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR CURB P.L. M.L.TO P.L. Q.) -'
Pi TS AND/OR DRAINFIELD @ $3.00
_F
-
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL. DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO f -::' 4: P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $i.d0 CO.fMP.N0. ->,,�' �-,' JOB N0.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0.`
WORK.TO HOUSE SEWER @ $1.00
ALTER:REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOS L SYSTL-M @ $1.00 PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PEAI�+iIT $ 2 00 CONNECTION CHARGE FEE
AUTH=ORIZATION TOTAL FEE '" '>--'S 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 DAY OF 19_ NEW HOUSE SEWER I
OWNER OR CONNECT ADDITIONAL
OWNERSAGENTc#Y BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S)
- --- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE 7L HAT 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 REQUiRX' ,L4S AfiGfiLJz� COUNTY AND $FATE OF
CALIFORNIA OR T,l } 6A-,THE �,Od7(Ai.E$