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HomeMy Public PortalAbout4965 MCCLINTOCK AVE_Sewer__ DEPAUTNIEIITT OF COUNTY ENGIIVEER ' SEWER-SEWAGE DISPOSAL �. DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES J WILLIAM J. FOX, COUNTY ENGINEER I BUILDING ADDRE8S - FOR APPLICANT TO FILL IN LOCALITY '� r°�dj,/7-� BUILDING p v NEAREST ADDRESS 7� C `�'e a CROSS ST. LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST ` - I' s!r'• �' ^ CR088 ST. h �7 RE EIVED Y ' Ready for Inspection D SSUED OWNER MAIL ADDRESS SE ZON OCCUPANCY BK MA PG CITY TELAO. e /9—/ CONTRACTOR '�i CO.IMP.NO. ADDRESS 7.1- t JOB NO. CITY eL TEL.NO.r Q.�.���5 q TRUNK PERMIT NO. / STATE. REGISTRATION NO. 'u ®. COUNTY ROAD PERMIT NO. LEGAL �gam. STATE ENCROACHMEN DESCRIPTION LOT N0. J PERMIT I BLOCK TRACT 1I J®2. INDUSTRIAL � 'y WASTE APPROVAL SIZE OF LOT `��n I,y J'�NOW ON LOTS HARGES USE OF BUILDINGS CONNECTION CHARGE E NO. DESCRIPTION OF WORK FEE - HOUSE SEWER CONNECTING TO REIMBURSEMENT F PUBLICSEWER G $ 9.50 RECEIPT NO: , I DATE BY OUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 d O' CONNECT ADDITIONAL BLDG.OR _ EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER-OR REPAIR EXISTING ipPER ' DATE .BY EWER OR DISPOSAL SYSTEM. 1.00 'DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 NECTION•DATA SEP IC TANK,'SEEPAGE PIT OR PITS AND/ORDRAINFIELD 2.00STATION DEPTH CESSPOOL—DRYWELL -SPECIAL CONDITIONS ONLY 2.00 �!i9O REFERENCE LOWER TYPE OF,CO ECTI N LENGTH.FROM OWNERS PERMIT ¢ 1 _00 Y. CU P.L. M.L.TO P.L. AUTHORIZATION TOTAL FEE ©v 1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE DWELLING TO THE PUBLIC SEWER SIGNED TH15._.__.__.....DAY.OF:..___._._.___. 19...... NEW HOUSE SEWER OWNER OR - CONNECT ADDITIONAL OWNERS AGENT......._.........._......_.........._ BUILDING OR WORK ADDRESS..._.._............... SEPTIC TANK,SEEP.PIT(S). �... - -._...._._..._....._.........._.._......_... AND/OR DRAINFIELD - I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL Q DRYWELL CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,'SEWER OR REGULATING PLUMBING AND SEWERS: SEWAGE DISPOSAL'SYSTEM 1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY . ABANDON HOUSE SEWER AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. - BACKFILL,SEPTIC TANKS.[] SIGNATURE SEEP.PIT(S)[j CESSPOOLS.[] OF PERMITTEE.__ 1ti__ _�._ .___.____ 78AB42A 883 7/53 S°u ZU E,St 2•5,e APPLICATION FOR PERMIT DIVISION OF BUMDING AND SAFETY SEWER-SEWAGE D I SPOS1#L Department of County Engineer County of Los Angeles BUILDtNG WM.J. FOX, COUNTY ENGINEER ADDRESS -- CASSA'TT 0. GRIFFIN,5UP'T OR 8UILOiN;• LOCALITY FOR APPLICANT TO FILL IN NE ARE9T — - _._...___..... CROSS ST, LEGAL —_ DF-SCRI.PTI_C_td L0T NO. � OWNER BLOCK TRACT MAIL - " . NO. OF BLDGS. - SIZE OF'LOT NOW.ON_LOT CITY TEL. NO. -'--- USF'OF BUILDINGS DISTRICT NO. GROUP i MAP SK PG CONTRACTOR �,. •�: -_ * J ADDRESST` ('.®l'alvfr.^TlOra DATA CITY TEL. N0. _ _ - - --- - STATION DEPTH L] STATE MANHOLE REFERENC REGISTRATION N0. -COUNTY -.-.,.-_-__.—, -+,"��r�*- f'.. �_ 1''y,•_LOViLR TYPE OF CONNECTION' LENGTH FROM NO. f DESCRIPTION OF VrORKV FEE Y. CURB "P.s.-. hs_L,TO P.L. ____. r ; HOUSE:SEWER CONNECTING To _r PUBLIC EATER_ 3.50 _ __ (W S 1: --- --- HOUSE SEWER CONNECTING 70 --_------—�� -`�-- �_� PRIVATE DISPOSAL SYSTEM _ 7.00 FNBLDG, j I ' COhECT ADDITIONAL BLDG_OR �! ^�-�- +CO, IMP.NO. JOB. N0. -- WOR�C THOUSE_SEWht_K__ ALTER,OR REPAR LX ISTENG SEWER OR DISI `SAL SYSTEM i.0 � � TRUNK PERMIT NO. ROAD PERMIT N0, Da C,O 11 C OSA SYS DO—N_SEWER CG STATE ENCROACHM041;... AND,OR D ti GSA SYSTEM g_,:..�.-_.' P.:RMiT NO SCP _C TANK.SEE PPf t PIT OR PITS AND OP DRAINFIEL-D 2.00 'INDUSTRIAL ._._._. ._ _ --.. `. C. SPOOL DR'?:V t.LL WASTE APPROVAL SPL CAL CONDITIONS ONLY 2.00 CEL? .sES I` �.Oe'r1��,LigS I_._--- C;NNECT:ON CHARGE F°c _ •�, PERMIT 00 - - AUTI40RIZATION TOTAL FE.E _ R_rMBUR Etd �TFEE �. t, a. I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- TRACTOR TO CONiNECT THE ABOVE DESCRIBE? EXISTING D� LLL.NG. `�ti APPROVALS � DATE f 1NSPt TOR"S SCNFTURE TO THE PUBLIC SEWER - SIGNED TH(S_.�_-DAY OF--- NEW HOUSE s=ti`t,_R OWNER OR CONNECT ADDITIONAL., - - OWNERS AGENT. _ � BUILDING OR WORK SEPTIC TANK SEEP, PIT(:) ADDRESS.--- .___ � _...=.. _ _ _ Ar=D;_O RG RA1_Ti FIELD_ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL 0 DRYWE:LL❑ AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 5 ALTER, REPAIR,SEWER OR PLUI4BING AND SEWERS. SEWAGE DISPOSAL SYSTEM I HERE3Y CERTIFY THAT I AIA PROPERLY REGIST7RED AND!OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL, OWNER OF THE ABOVE ARA�NDON HOUSE SEWER _ L'ESCRISED .RESIDENTIAL. PROPERTY. BACKFILL SEPTIC TANKS 0 C S4:Bp.PIT(S) Q CESSPOOLS_ SIGNATURE _ OF PERMITTfE.—___ - _ WILLIAM J. Fox, C'.,ouNTY ENGINEER VAIMATION BY BY DEPUCY ,:,i DEPUTY BY BY Q I)7PUTY DEPUTY