HomeMy Public PortalAbout4946 MCCLINTOCK AVE_Sewer__ 78A�s4RD APPLICATION FOR PERMIT - 1
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
CA.SSATTO. GRIFFIN, SUPT of BUILDING LOCALITY
FOR APPLICANT TO FILL IN cross sr,-
LEGAL -- L-.
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DESCRIPTION LOT NO:-'' �' �� r f" ' OWNER -
BLOCK ,ice'" TRACT ll � Q,_� _" - MAIL
° -f" s� ,' ';--Y ADDRESS ,_---- -----------
NO.OF BLDGS.
_SiZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF ..-:_._.. --- ------"
BU1LDIDISTRICT N0, GROUP I MAPhGS
FG
CONTRACTOR
-
ADDRESS
CONNECTION DATA
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STATION• .:° DEPTH
CITY .� _ TEL NO MANHOLE REFERENCE IV
Q STkTE _ _ aCO_11WES
REGISTRATION NO.,, [] COUNTY ---- ------... --f?—. a .J '`-
NO. i DESCRIPTION OF WORK FEE
- - -- - --- - --- 3`_ -1" ---- TYPE OF CONNECT
10 pk- 'LENGTH FROM _
HOUSE SEWER CONNECTING TO Y CURB P.L, M.L. TO P.L. !'
PUBLIC SEWER ... -
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Vill $3.00. _ --- ---- _- -----
- --- ----- -` --= P. C. NO.
OVERFLO"N SEEPAGE PIT, DRAINFIELD -
FXTN ,CESSPOOL,DRY ELL MANHOLE �t $2,C0 CC, IMP. NO, t f r: J0B NO.
-- — -- -
_ --- --
HOUSE SEWER CONNECTING TO
PRIVATE 1)ISPOS.AL SYS-T-EM (rc $i.DD I TRUNK PERMIT NO
CONNECT ADDITIONALBLDG.OR
i � si`A°"s-mELQROACHMENT
VfORK TO HOUSE SEWER (3' $I,OD PERMIT NOS"'-`-'-•ALTER,REPAIR OR ABANDON HOUSE --R _ _—
INDUSTRIAL
S EWEROR DISPOSAL SYSTEM �o $IEC
_ .----- . _ .. _ -..- WASTE APPROVAL i
- CHARGES
CONNIF TION CHARGE FEE
OWNER'S PERMIT � — �� 00 -� --- ---- --- — -- ----
----- ---------- -
--
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE t' T
AL
I HAVE A7 THIS UATE.A CONTRACT WITH THE HEREIN NAMED CON- - APPROVALS .DATE. I INSPECTOR'S SIGNATURE
TRACTOR TO CONNE . EX!S
T THE ABOVE DESCRIBED ----_._- ----- - -
'SING DWELLING
TO THE °UBLIC SEWER. NEW HOUSE SEWER _
SIGNED THIS------DAY O _-- _.19_—
CONNECT ADDITIONAL
OWNER OR '' -�" '`� y _BUILDING OR WORK
OWNERS AGENT ' i �' >%.
- � SEPTIC TANK,5 tP PTT'ISl
-ADDRES5 r AND/OR DP.AINv__LD
1 HEREBY ACKNOWLEDGE THA' I HAVE READ THIS APPLICATION CESSPOOL L' DRYWELL Q
AND STATE THAI -HE -
ABOVE IS CORRECT AND AGREE TO COMPLY .._.. - ___.... ___I ___
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR I
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
__-.--- ---- -
'
-HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AN D,'UR DISCONNECT PLUG AND I j
LICENSED AS REQUIRES} BY LOS ANGELES COUNTY AND STATE OF _ABANDOIJ HOUSE SEWER
c -_. __. -.
CALIFORNIA OR THAT I ARI THE LEGAL OWNER OF THE ABOVE '
DESCRIBED RESIDENTIAL PROPERTY. BACKFI[L SEPTIC TANKS[,
SIG-NATURE SPEP Plri'j a CESSPOOLSQ
OF PERMIT1'EE.,�..
JOHN A. LAMBIE, COUNTY ONGINEER r._�TALIDATION ROBERT A. WOOD, CHIEF PLBG, INSPECTOR
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,-CK, - H. U. CASH
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