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Home My Public Portal About5104 MCCLINTOCK AVE_Sewer__ on"z y rL.E4 Ca � lb E808 8 8 8.59 APPLICATION FOR PERMIT e8D7 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL i■ DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING p y� ADDRESS l V - ;v/c- JOHN A. LAMBIE, Count. Engineer CASSATT D. GRIFFIN,Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL f DESCRIPTION LOT NO. OWNER BLOCK TRACT MAIL PP? ! ADDRESS N0.OF BLD S. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP PRQCESSED BY _ r-• BK PG ) CONTRACTOR51, -:� .,.} . �` ,. d ', .. —,fir'. ..- ji 4 ADDRESS ."'>` CONNECTION DATA CITY TEL.NO- C54 & STATION DEPTH / A. STATE MANHOLE R�FERFXCE UPPER REGISTRATION NO. ® COUNTY s' t° LOWER NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO W ��-' ✓ a .1• 'r PUBLIC SEWER @ $8.00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M,L.TO P.L. PITS AND/OR DRAINFIELD @ S3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL,DRYWELL C $2.00 i HOUSE SEWER CONNECTING TO P.,, ;N0. �• PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. ��. -s'DB NO. CONNECT ADDITIONAL BLDG.OR J TRUNK PERMIT NO. ROAD PERMIT NO. WORK 70 HOUSE SEWER �� $1.00 J_ � _ �� ALTER.REPAIR OR ABANDON HOUSE C� If--�- STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM $1.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL _ L CHARGES OWNERS PERMIT S 2 CIO CONNECTION CHARGE FEE AUTHORIZATION TOTAL. FEE `y.Ll/' REIMBURSEMENT FEE I HAVE AT THIS DATE CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 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 THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. gLTER,REPAIR,SEWER OR SEWAGE DISPOSAL SYSTEM I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT DISPOSAL SYSTEM D LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT ABANDON CT PLUGHOUSE AND CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE DESCRIBED RESIDE - IAL I ROPERTY. BACKFILL SEPTIC TANKS ❑ SIGNATUREId SEEP.PIT(S) ❑ CESSPOOLS ❑ OF PERMIT I VALIDATION ROBERT A. waoQ _6 f CK, j' 11.0. QUH SUPERVISING MECHANICAL ENGINEER 7 DEPAWMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY- PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ! ADDRESS �_- FOR APPLICMT TOeFILL IN LOCALITY BUILDING ;-- ADDRESS �: 'S - — �, " c -� NEAREST _ t' CROSS ST. LOCALITY �� DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST - ------ e' w ) A s CROSS ST. -� 6EC•EIVED BY Ready for Inspection I- DATE ISSUED OWNER _ I � � MAIL ."-.`-• - --- -. ADDRESS �i? / a t USE ZONE OCCUPANCY BY MAP PG -- - _ _ CONTRACTOR p CO.IMP.NO. ADDRESS a -` JOB NO. TEL. TRUNK PERMIT NO. REGISTRATION N0. r,%ais7 E ,'� �= °� COUNTY . ROAD PERMIT N0. LEGAL STATE ENCROACHMENT DESCRIPTION LOT NO. PERMIT NO. BLOCK TRACT I ' INDUSTRIAL 3 r WASTE APPROVAL SIZE OF LOT NO.OF BLOGS. p _ NOW ON LOT CHARGES USE OF BUILDINGS "' _;; CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE'"' REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO _10 r r F PUBLIC SEWER @ $ 3.50 --5. h !y RECEIPT NO. I DATE +BY kOUSE 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 1100 I I 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—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MAN;iuLE REFERENCE UPPFP: TYPE OF CONNECTION LENGTH FROM OWNERSPERMIT i I Lol Y. CURB P.L. M.L.TO P.L. 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___,_.-------DAY OF......c .rt!.__._...19LgJ NEW HOUSE SEWER OWNER OR / CONNECT ADDITIONAL r OWNERS AGENT .................. BUILDING OR WORK SEPTIC TANK,SEEP.PIT(S) ADDRESS ....,.-a -•- ----- --- •-r 4 i-•-f'� -•------- AND/OR DRAINFIELD (� 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLI- CESSPOOL O DRYWELL 11CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR i - 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 DESCRIBED JWSIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SEEP.PIT(S)E I CESSPOOLS E] SIGNATURE -� rr : OF PERMITTE ..__._' .- .•__... 76A642A 663 7/53