HomeMy Public PortalAbout4929 MCCLINTOCK AVE_Sewer__ 76A6420
E-663 fl-55 APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer I
County of Los Angeles BUILDING
JOHN A. LAMBIE,COUNTY ENGINEER ADDRESS
CASSATT D.GRIFFIN, SUP-'T OF BUILDING LOCALITY
FOR APPLICANT TO FILL A ST
CROSS��T
LEGAL �DESCRIPTION LOT NO OWNERr
f-1 L '7
TRACT
BLOCK AD MAI
DRESS
NO.OF 5LDGS CITY
SIZE OF LOT NOW ON LOT TEL.-N0.
USE OF
DISTRICT NO, GROUP MAP
I I BK PC
7
CONTRACTOR 'C7
CONNECTION DATA
ADDRESS 4.
STATION DEPTH --1
CITY :��
TEL. NO.
MANHOLE REFERENCE UPPER
-L-1, STATE
REGISTRATION NO. COUNTY
NO. 1 DESCRIPTION OF WORK FEE
TYPE OF CONNECTIOV—'�� LENGTH FROM
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3,501 Y. CURB j P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
_PITS AND/OR DRAINFIELD @ $2.(10
I OVERFLOW SEEPAGE PIT, DRAINFIELD r P. C. NO.
EXTN CESSPOOL,DRYWE,Lj&ANHOLE62 $2.00
TAI-P:_-NO. JOB NO.
i HOUSE SEWER CONNECTING TO ---r--
PRIVATE DISPOSAL SYSTEM ( $1.00 I. .TRUNK PERMIT NO. ROAD 'PERMIT NO.
CONNECT ADDITIONAL.BLDG.OR
STATE ENCROACHMENT
WORK TO HOUSE SEWER $1,01)
PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT
j_ o�--- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC S-WEP. NEW HOUSE SEWER
SIGNED THUSDADDITIONALCONECT ADDITIONAL
OWNER OR = 'iU!LDfNG OR WORK
OWNERS AG NT
A SEPTIC TANK,SEEP PIT(9)
A ND/OR DRAINFIELD
4
I HEREFY ACKNOINLEP(E THAT I HAVE READ THIS APRLiCATION
AND STATE THAT COMPLY
T YHE ABOVE 19 CORRECT AND AGREE TO CESSPOOLL�l DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER.REPAIR,SEWER OR
PLUMBING AND SBVERS, SEINA-GE DISPOSAL-SYSTEM
STEM
- -
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/QR DISCONNECT PLUG AND
LICENSED 1,5 REQUIiRID BY LOS ANGELES 'COUNTY AND STATE OF
CALIFORNIA OR THAT I AM, THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEINE
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS
SEEP. PIT
CESSPOOLSSIGNATURE - -
OF
PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER ALIDATION ROBERT A. WOOD,CHIEF PLEIG. INSPECTOR
'A
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