HomeMy Public PortalAbout4954 MCCLINTOCK AVE_Sewer__ 7BA6420 APPLICATION FOR PERMIT 1
3&E-663 11-55
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE,COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT Or BUILDING - LOCALITY - ------
NEAREST
FOR APPLI F�DIT TO FILL IN m CROSS ST,—
_ 1,
.LEGAL OWNER
DESCRIPTION LOT NO`.
y,, - -
BLOCK TRACT MAIL- ADDRESS
NO, OF BLDGS. CITY TEL. NO,
SIZE OF LOT NOW ON LOT
USE.OF ---
BUILDINGS DISTRICT NO. GROUP MAP
PG
CONTRACTOR
CONNECTION DATA — —
ADDRESS
--- — - _ ...STATION ' sI___,. DEPTH ��--•Y-=+
CITY- e TEL N0, = ----- -`='-
MANHOLE REFERENCE
REGISTRATION NO. ,.;� ❑ COUNTY
NO. ! DESCRIPTION OF WORK FEE --•-- ----- --_. _---
- OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TD _ .1 _�I y CURB P.L. PaI L.TO P.L.
I PUBLdCSEWER @ $-3..694 �� ---- ---- _..—
SEPTIC TANK SEEPAGE PIT OR !
PITS ANDiOR DRAINFIELD $3.00 - ----.— - _
OVERFLOW SEEPAGE PIT DRAINFIELD -- - -
_ Ex7N ,CESSPGOL,DRYW_E_LL:M,4„HCLE.Cu' --- " P C N0. .
_ $2.00 CO. IMP 70H NO. . ;
HOUSE SEWER CONNECTING 1'0 `. '.
PRIVATE DISPOSAL SYSTEM ca) s 1.000 I TRUNK PERMIT NO. ROAD PERMIT NO.
! CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT
` WORK'TO HOUSE SEWER kc $1.00 f PERMIT NO.
ALTER,REPAIR OR hBANUGh HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM.-
WASTE APPROVAL
! CHARGES
i
— --_--.--------- �_----------_- CONNECTION CHARGE FEE -
OWNER'S PERMIT00 ---------- — ---.-----------_�—_._.-----
ftETMBURSEMENT.FEE
AUTHORIZATION roTAr FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
'TRACTOR TO CONNECT THE APOV'E DESCRIBED EXISIING DWELLING � �I-- --- --------- -
TO THE PUBLIC EV ER. NEW HOUSE SEWER �. !
,SIGNED 71115 ----DAY OF_ (pNNECl ADDITIONAL
OWNER OR ` - BUILDiN„ OR,YORK
OWNERS koERT �--�� SEPTIC TANK,SEEP,PIT(5)
ADDRESS— AND/OR DRAINF ELD
I HFRErY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOpLI l DRYWEl.L❑
AND STATE 7h AT ,HE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAVVS REGULATING ALTER REPAIR SEWER OR '
PLUMBING AND SEWtRS. SEWAGE DISPOSAL SYSTEM 1__--_.-.---.--__--_-_
1 hEP .__.—._- _ _-- -_.__.__._
v CERTIFY THAT I AM PROPERLY REGISTERED A.ND%OR !
LICENSED A:; REQUIRED BY LOS ANGELES COUNTY AND STATE: OF
DISCONNECT PLUG AND '
CALIFORNIA, OR THAT I AM 'THE LEGAL OWNER OF THE ABOVE __ABANDON HOUSE SF_WER --i-- -- _-DESCRIBED RESIDENTIAL RESIDENTIAL PROPERTY. n <"' BACKFILL SEPTIC TANKS[�
SEEP_P1TES?L7 CESSPOOLS❑
:SIGNATURE >� rk' i f - --- - ----- ----- ---...-- ---- -----
OF PERMITTEE
!
IOHIN A. LAMBIE, COUNTY ENGINEER VALIMATION ROBERT A.WOOD, CHIEF PLBO, INSPECTOR
CK, N,0. CASH
A