HomeMy Public PortalAbout5018 MCCLINTOCK AVE_Sewer__ DEPARTBIEN'I' OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL3 3 8 8 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING C :,
ADDRESS ( Z f& Ll ,�U��r,/
FOR APPLICANT TO FILL IN LOCALITY
ADDRESS 5018 McClintock CROSS ST. !� F�' •�`n �
LOCALITY E1 Monte DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST
A � S
CROSS ST. `�rL(.y�iCl�, gECEIVED BY Ready for Inspection D TE=IISSUED
OWNER 119R, Stone �� '� - lF
MAIL
ADDRESS Same USE ZONE jr OCCUPANCY BK MAP PG
CITY TEL.NO.
CONTRACT1a11f ornla Sever nnct.00_ CO.IMP.NO.
ADDRESS 1317 Cole rove AV9.. JOB NO. r
cITnl,nytebello TEL.bVjn j_SQA8 TRUNK PER TNG.
REGISTRATION NNA�'r4rJ COUNTY ROAD PERMIT 1110LEGA .
DESCRIPTION LOT N0.!&, `(� L , - , STATE ENCROACH MEN
/ PERMIT NO.
/
BLOCK TRACT 3 / INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT,4j, NO.OF
,r6
NOW ON LOTS CHAR
USE OF / ��
BUILDINGS f-- I CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $ 8.50 3150 RECEIPT ND. I DATE I B
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- i DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
DEPTH
PITS AND/OR DRAINFIELD 2.00 STATION r • , l
CESSPOOL—DRYWELL �' ` (
SPECIAL CONDITIONS ONLY 2.00 !j/ irj c MANHO EREFERENCE
UP
TYPE OF COfNECTIONLENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB P.L. y M.L.TO P.L.
AUTHORIZATION I TOTAL FEE I C50
I 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 ,�j`
SIGNED THIS...k__.�...DAY OF JLIL—_ I NEW HOUSE SEWER z-,
.i-L `` 100,`-
OWNER OR t / CONNECT ADDITIONAL
c
_
OWNERS AGENT.. ,l_ icy BUILDING OR WORK
ADDRESS............ .� _. AND/ OR DRAINFIEEPTIC TANKLD PIT(S)
1 HEREBY ACKNULIDIUNHAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL I]
.AT
AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATINGPLUMBING 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 1 AM THE LEGAL OWN-
ER OF THE ABOVE D SCRIBE RESIDENTIAL P OPERTY. BACKFILL SEPTIC TANKS❑ A c� _ r
SEEP.PIT(S)[] CESSPOOLSi�.
SIGNATURE � o _f�� P
OF PERMITTEE... o_._._. .._._ _.._.._.._...._._.._...
7BAS42AA 862 7/53