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HomeMy Public PortalAbout5034 MCCLINTOCK AVE_Sewer__ DEPAZCrMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND,SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES ( BUILDING WILLIAM J. FOX, COUNTY ENGINEER jj ADDRESS FOR APPLICANT TO FILL IN_. . LOCALITY BUILDIN NEAREST ADDRESS CROSS ST. LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST A s CROSS ST. RECEIVED BY Ready for Inspection DATE ISSUED OWNER ° MAILees USE ZONE OCCUPANCY � BK MAP PG ADDRESS CITY' TELAO. CONTRACTOR CO.IMP.NO. ADDRESS --- — _� _ JOB NO. CITY _—_— TEL.NO. TRUNK PERMIT NO. REGISTRATION NOE y COUNTY ROAD PERMIT NO.`, LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO. PERMIT NO. BLOCK TRACT33 si�y WASSTRIAL TE APPROVAL SIZE OF LOT NO.OF BLDGS. CHARGES NOW ON LOT C(M USE OF BUILDINGS CONNECTION CHARGE FEE N0. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO { PUBLIC SEWER @ $ 3.50 �I ,, - RECEIPT NO. DATE BY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED _WORK TO HOUSE SEWER 1.00 NO DATE BY ALTER OR REPAIR EXISTING SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER _ AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA SEPTIC TANK,SEEPAGE PIT OR --PITS AND/OR DRAINFIELD 2.00 I STATION DEPTH r- CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 j u MAN"OLZ IEFERENCE 'UPFER Ls R TYPE OF CONNECTION 'LENGTH FROM , M Z OWNERS PERMIT _ i pO Y. CURB P.L. M.L.TO P.L. r AUTHORIZATION I TOTAL FEE 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 THIS......y�-/j� D Y OF.. a....19 NEW HOUSE SEWER 1 OWNER OR > CONNECT ADDITIONAL p" l i✓ BUILDING OR WORK OWNERS AUNT...... ` e .---. ..... r $ SEPTIC TANK,SEEP.PIT(S) ADDRESS -- AND/OR DRAINFIELD 1 HEREBY ACK WLEDGE THAT i HAVE READ THIS APPLI- CESSPOOL© DRYWELL E CATION AND STA E 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 AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND AND STATE OF CALIFORNIA THAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER ER OF THE ABOVE DES RESIDE�/NTIAL,P RTY. BACKFILL SEPTIC TANKS& SEEP.PIT(S)Ej CESSPOOLS ' SIGNATURE -' OF PERMITTE .._ :. .'`. :— .. --- - ..........—....... 76A642A 663 7/53 t ,.�. t