HomeMy Public PortalAbout4938 MCCLINTOCK AVE_Sewer__ '`AE-663 i2.5S APPLICATION FOR PERMIT 1
E.66
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE D 1 SPOSA L
Department of County Engineer
County of Los Angeles BUILDING Q"'
WM.J. FOX, COUNTY EINGINEERADDRESS ... -
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CASSATT D. GRIFFIN. SUPP'T Or BUILDING -LOCALITY ti �--• ✓,.�, ,�
FOR APPLICANT TO FILL IN NEAREST o
_Cn OSS ST.
LEGAL —^—^'-
DES.CRfPT1oN_ LOT NO. ... v_ .? ��.�_ OWNER
BLOCK TRACT yy��Y. MAIL
ADDRESS-
NO
DDR'ES '�"• t...�- -.
f gg NO OF SLDGS.
SIZE OF LOT/ - 1` NOW ON LOTCITY q ,s TEL, NO.
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BLILDlNGS ". i.✓ P'6.�"' LiSTR4 CT ROUP MAP
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CONTRACTOR/ ` >t'� +' _ (5'.�. y� .
ADDRESS _ CONNECTION DATA+~'��_�`
CITY STATION
L. r DEPTH -
�_ STATE --
�� MANHOLE REFERENCE
. REGISTRATION NO. ,. - Q COUNTY t tOh'E_R_
------- ------°- TYPE OF CONNE"TI. LENGTH FR06t .J�;•^
NO, I
DESCRIPTION OF WORK FEE -Y. CURB P. M.L.TO P.L, r
HOUSE SEWER CONNECTING TQ - -�' ( - v'---�A�' y
11UBL1C SEVl ER _ Cad $ 3 b0 " f
HOUSE SEWER CONNECTING TO i
PR(VA7"L DISPOSAL SYSTEM
CONNECT
----
CONN.EC ADDITIONAL BLDG. OR -�
CO. IMP, N0. JOB. !'d0.
,.WOKE TO HOUSE SEWER 1.00
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ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 I TRUNK PERMIT N.O. ROAD PERMIT NO.
--
DISCONNECT AND ABAIdDCI•t Sr:.WER i S`_ATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM__ PERhf f N0.
SEPTIC TA4 K SELYA
_-GE PIT OR--
PITS APdDJJR DRA NF1E_D 2,00 I INDUSTRIALLWA T-APPROVAL I
i CESSPOOL DRYVu ELL
PECIAL CONDITIONSONLY 2.00
-.— —_ — CHARGES
i
CONNECTION CHARGE FEE
OWNEWS —PERMIT S ) I 0�
AUTHORIZATION TOTAL FEE Rri MBurrsEME dT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR 'f0 CONNECT THE A 'SOVE DEBED EXIST IPi^ DV E I ING APPROVALS
TO THE PUBLIC SE 'R
SIGNED THIS i�AY OF �9 �9 NEW HOUSE SEWER --
_.�.
OWNER CONNECT PGD.?IADDITIONALAG a ,. t f U
OWNERS AG - t ___BILDING OR iVORK_-
SEPTIC TANK SEEP. PIT(S)
AND/OR DRA.Ih IELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CT.SSPOOL 0 DRYWELL 0
AD.'D STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLYWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING AL"'ER, R£PAIR,SEWER OR
PLUMBING AND SEWERS. _SrVIAGE DSSPOSAL SYSTEM _
I HEREBY CERTIFY THAT I AM PPOP>':'RLY REGISTERED AND/OR NECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCOND'SCONN HOUSE SEWER _
CALIFORNIA OR TH.A'T I AM THE LEGAL OWNER OF THE ABOVEi-_.._., -
DESCRIBED RESIDENTIAL PROPERTY. +a BACKFILL SEPTIC TANKS Q
SSFP P9T(S) ® CESSPOOLS Q
SIrRATURP. J7 _. _..__ --— - --
OF Pn?,1iTTEE
WILLIAM J. FOX, COUNTY SING EER VALIDATION —
LN
By BY
6.5
DEPUTY. DEPUTY
BY BY
�7 DEPUTY DEPUTY