HomeMy Public PortalAbout5024 MCCLINTOCK AVE_Sewer__ ' DEPARTN ENT OF COUNTY ENGINEER SEWER SEWAGE DISPOSAL3 3 8 9 1
-DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS _5_,0 C.
FOR APPLICANT TO FILL IN LOCALITYBUILDIN
EST
ADDRESS CROSS ST.
b.f124 l�cMlintnck
LOCALITY EE1 kont$ DISTRICT NO. SERIAL NO. PERMIT N0, c
NEAREST
ST.C t JL(/iJY�l+, A �� J
/RIOEIVED BY Ready for Inspection DATE ISSUED
OWNER w• L. Briggs
MAIL
ADDRESS �Cl$$ e USE MAP
d OCCUPANCY BK PQ
CITY TEL.NO.
CONTRACTOlfl
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ADDRESS 1317. On' ng-^f'. m lush -- JOB NO:
CITyMontebel In TEL.M%.7-r nr3 Z—Rf-w_t 0 TRUNK PER IT NO.
STATE
REGISTRATION Ng'04 }' ,COUNTY ROAD PERMIT
LEGAL 1' c
DESCRIPTION LOT N0. .��• / STATE ENCROACH NTPERMIT N0:
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT. Di� K� C NOW ON LOTS <1 RGES
USBUILDINGS Re$e r• CONNECTION CHARGE E
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENTXE
PUBLICSEWER @ $ 8.50 3 RECEIPT DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATEDISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECOR D
WORK TO HOUSE SEWER 1.00:
ALTER GR
'REPAIR EXISTING N0. 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 /
PITSANB/OR DRAI NFIELD 2.00 STATION �/�'—��j DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / MANHOLE REFERENCE
3 T� NO/� tlaRm 6:0
TYPE OF CONNECTION ENGTH FROM
OWNERS PERMIT 1 00 Y. CURB P.L. Nf M.L.TO_.
AUTHORIZATION I TOTAL FEE 1 450
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PUPLIC,SEWE�R,
SIGNED THIS..___..._. ..DAY Of'�✓1�Y..___..14� NEW HOUSE SEWER ��n'•rie�. � !�� �
OWNECONNECT ADDITIONAL - !r
OWNERS AGORENT._ '� b �` BUILDING OR WORK
SEPADDRESS..........._.._. -_y .Z� �S�� .. AND/ORDRIC AINFIELDIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND 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 ESIDENTIALP ERTY. BACKFILL SEPTIC TANKS �� P'
C SEEP.PIT(S)E] CESSPOOLS -. •�I,.� p .
SOF PERMITTEE. V t - _—r--. ....•..
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