HomeMy Public PortalAbout4931 MCCLINTOCK AVE_Sewer__ GA6a as' APPLICATION FOR PERMIT
COUNTY of LOS ANGELES SEWER-SEWAGE D40SAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING C �. 10jtq__JOHN A, LAMBIE, Couatg Enq/seerADDRESSWILLIAM A. JENSEN. Supt of Building LOCALITY NEARESTa 1tiFOR APPLICANT TO FH1 IN CROSS ST. -� -
LEGALOWNERS lw° i,5+0�......C=DESCRIPTION LO7 LA0.442
BLOCK TRACT �/ x ` ;,A&iL 1'SANO.OF BLDGS.
SIZE OF LOT NOW ON LOT V CITY€ J TEL. H0.
USE OF -4
BUILDINGS y I / r DISTRICT LA0. GROUP' MAP PROCESSED BY
-'a9 BK PG = 7
CONTRACTOR '/
L 1
ADDRESS .�✓r r � ' CONNECTION DATA
CITY �' TEL.LA0, ,% STATION - ' - DEPTH
REGISTRATION NO. d ���
COUNTY MANHOLE REFERENCE % ✓ UPPER
NO. DESCRIPTION OI _Yd_R FEE —
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.
PITS AND/OR DRAINFIELD (� S3.00
OVERFLOW SEEPAGE.PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
LL
HOUSE SEWER CONNECTING TO - / — P.C>NO. O
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO, l.J
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. `
WORK TO HOUSE SEWER $1.00 � 9
SEWER'ORDISPOSAL SYSTEM HOUSE @ $9 00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL Uj
WASTE APPROVAL
CJ9
CHARGES Z
OWNEWS FERMM ,� pQ CONNECTION CHARGE FEE e
AUTHORIZATION TOTAL FEE k> REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT TRS,XBOV"B SCRIBED,EXISTING DWEL ING, APPROVALS DATE INSPECTOR'S SIGNATURE`
TO THE PUBLIC SEWER., r
SIGNED THIS
nj �dF, i " NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT. BUILDING OR WORK
ADDRESS b' .y' SEPTIC TANK,SEEP;PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I H READ THIS APPLICATION
AND STATE THAT THE ABOVE IS G0 CT 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED A5 REQU 81y LDS ANGELE .,.0 NTY AND STATE OF ABANDON HOUSE SEWER
:CALIFORNIA OR IM THE LEG NER OF THE ABOVE BACKFILL SEPTIC TANKS
DESCRIBED REST TI PROPERTY.
SIGNATURE -' SEEP.PIT(S) ❑ CESSP00LS
OF PER.MITTE ��
VALIDATION ROBERT A. WOOD
CK. Y.0, ,,6H J SUPERVISING MECHANICAL ENGINEER
., 0,1
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