HomeMy Public PortalAbout5019 MCCLINTOCK AVE_Sewer__ DEPAtin=NT OF COUNTY ENGINEER SEXIER—SEWAGE DISPOSAL-3 3 8 7 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENNBUILDING
- GIEER Ii I ADDRESS �0 / � /�ij C.(��•��
FOR APPLICANT TO FILL IN I LOCALITY 'y� ,t,; �; '
ADDRUILDESS '5019 MC Clintock OROSSST. e
LOCALITY El Monte ff DISTRICT NO. SERIAL NO. �:PERMIT NO.NEAEST c'
CROSS ST. A '�jA �JJ
REG E VED BY Ready for Inspection DATE ISSUED
OWNER H• L. Malone
ADDRESS S ELME bSE ZONE ' OCCUPANCY - MAP
�® t� BK PG
CITY TEL.NO.
CONTRACTOR California .Sewer Const.Co, CO.IMP.NO. ?/ '
ADDRESS 1317 Colegrove Ave.
JOB NO.
CITY Montebello TELAOUNlon 1-5048 TRUNK PER011 N0. e,+�
`❑ STATE ,r
RE LEGAL
TION'N0.1QL�L��}5 St®(COUNTY ROAD'PERMIT NO. JJ
LEGAL �" J; STATE ENCROACHMEN ` f/
DESCRIPTION LOT N0. L/ PERMIT NO. \ ./
BLOCK TRACT�j`/�:/� ♦ INDUSTRIAL
APPROVAL
SIZE OF LO7� ®�/ -NOW ON LOTS �- CjROES
USE OF
\
BUILDINGS Res*.' CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE/
1 HOUSE SEWER CONNECTING TO
PUBLIOSEWER 0 $ 8.50 RECEIPT N0. I DATE BY
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 J NO. I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00 J
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA.
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 -STATION- � � DEPTH
CESSPOOL—O RY W ELL
-SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
�ipnco 2:L,tG�/IIA/ LOWER
TYPE OF.CONNECTION LENGTH FROM !��♦_
OWNERS PERMIT ;. 1 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION - TOTAL FEE 1 40 0
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 SEWE /
SIGNED THIS___�e _... lAY O � = _..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 TNA 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL Ej
CATIONAND 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
I 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 DE RI BE RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
L
SIGNATURE SEEP.PIT(S) CESSPOOLSIto
r_4 ,
OF PERMITTEE — ..
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