HomeMy Public PortalAbout5029 MCCLINTOCK AVE_Sewer__ 7GA6420
E-66�12-54APPL_ICA'T ION FOR PERMIT
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles. BUILDING UUzII L D I N G ,+a
'WM.J. FOX, COUNTY ENG[FIGER
241 7C 1,
CASSATT 0.GRIFFIN,SUP'T OF BUILDING LOCALITY Jdcw
FOR APPLICANT TO FILL IN NEAREST � ° 1 � 4�
LEGAL _
-DESCRIPTION_..... LOT NO. I p
�j OWNER
BLOCK TRACT gP 31 MAIL
ADDRESS
y�
NO. OF B LOB. � ,T-�
S(ZE Or'LOT' jl\ NOW ON LOT
CITY TEL. NO.
USE OF '
BUILDINGS » � tl DISTRICT N6. GROUP h!gP
DK PG
CONTRACTOR _. - F,_
ADDRESS �° R
LZ CAI; 'V L k -Ic -- - C0NNECTION DATA
CITY I ,,� A TEL. NO. STATION ;y �' f DEPTH
4 �3
4� ,{ ,t ❑ STATE r •y'; ,g�.�-' MANHOLE REFERENCE
REGISTRATION NO. f '� �"" Ll
F ❑' �,d� ,l._.-_-k^,F-&k R' �_�___ LOkV_FR_.-
"' - TYPE OF CONNECTION LENGTH FROM
NO. j DESCRIPTION OF WORK FEE _Y..•-- CURB P.L. M.L.TO P.L.
PUBLIC_SEWER __ (c5,$ 3.50
W
HO,I.S£SEER CONNEC"LING TO
PRIVATE DISPOSAL SYSTEM 1.00 --------
�I CONNECT ADDITIONAL BLDG. OR
_W ORK TO HOUSE 1.00 CO. IMP. NOj,'_: JOB. NO.
_ _ _
`j ALTER OR REPAIR EXISTING i
SEWER OR DISPOSAL SYSTEh1. i.00 j ! TRUNK PERMIT NO. ROAD PERMIT NO,
DISCONNECT AND ABANDON SEWER STATL ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 { { _
-PPM1TNO_
f SEI�IC AN(, SEEPA E PIT OR - - - --_I � -- -_�-----"-
TITS AND/OR DRAINFIELD 2.00 1� INDUSTRIn1_
CESSPOvL DRYWELL -- - - -i" WASTE APPROVAL _
SPECIALCONDITIONS ONLY 2.00 A 1 CHARGES
CaNNECTION CHARGE FEE
OWNER'S PERMIT s I 11 00 ------
AUTHORMA.TIONT�9T iL FEE ; I r'y REIMBURSEMENT_FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NA41ED CON- APPROVALS DATE' INSPECTOR'S S16NA1'U;2:.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING .
TO THE PUBLIC R _ ,� - ---•------------ - - -- ;___.
'„ NEW HOUSE SEWER
SIGNED THIS__- LAY OF
+CONNECT ADDITIONAL
OWNER OR BUILDING OR,WORK _
OWNERS AGENT '.k" �
SEPTIC TANK; SEEP,PIS)
ADDRESS— '•..- `� �! ° TAND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPI,!CATION CESSPOOL[ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO✓CO.MPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND;-OR DIS CUNNECTPLUG AND-
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE AND
_
CALIFORNIA OR THAT All T LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDYfIT PROPr!Y, "�.
3;17r'�
BAC`4FiLL SFPTICTANRS❑
EEP. P1T(S) ❑ CESSP^OLS❑S10F PERMITTE �, .,• .�. °' ._. _ ._
WILLIAM J. FCX, COUNTY ENGINEER VAIMATION .:.
By i$y 0 5 3 lnl FES 7 4 4.5 0By
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DEPUTY DEPUTY
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BY BY
DEPUTY DEPUTY