HomeMy Public PortalAbout5118 MCCLINTOCK AVE_Sewer__ nF.PARTHENr OF COVNW Tram SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COt3NW OF LOS ANGIUMS
WILLIAM J. FOX, COUNTY ENHINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING , NEAREST
ADDRESS 5i I " _& 4
CROSS S7.
LOCALITY A \J DISTRICT NO. Ready for Inspeetion � PERMIT NO.
NEAREST ' Y S
CROSS ST.
,l ! �rt-�'L ---__.--
�,j RECEIVED BY DATE I ISSUED BY DATE
OWNER
MAIL ---i-� yy w USE ZONE OCCUPANCY MAP
ADDRESS BK P8
CITY TELSO. -
CONTRACT01 a i f'.' r—nia Sewer Corint.I�^w
CO.IMP,NO.
ADDRESS
13-11 Co �.'v°ave Ave.
JOB.N0.
CITY -Montebello TEL.MO. TRUNK PERMIT NO.
REGISTRATION NJ0°445,, St 6 UN7Y
ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0.
PERMIT N0.
BLOCK TRACT INDUSTRIAL
HASTE APPROVAL
SIZE OF LOT jj' NO-OF BLDGS.
_ ( a NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTIO!tZHARGE FEE
NO.' DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO t_
-{PUBLIC SEWER af $58 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.04 i
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER1.00
ALTER OR REPAIR EXISTING NO- DATE 1 BYl
SEWER OR DISPOSAL SYSTEM 1.64
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRA.INFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL -
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
Ll6a5 (.OWES.
_ TYPE OF CONNECTION LENGTH FROM
Y. CURS P.L. M.L.TO P.L.
OWNERS PE1tM1T # ► (/o
AUTHORIZATION I TOTAL FEE --
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 SEWER
SIGNED THIS.__..,L 2DAY OF. /61L _._...__ 19 - NEW HOUSE SEWER
CONNECT ADDITIONAL
OWNER OR { ry r BUILDING OR WORK
OWNERS AGENT).)l I
5 * SEPTIC TANK,SEEP.PIT(S)
ADDRESS........-... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE T 1 VE READ THIS APPLI- CESSPOOL 0 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 1 AM PROPERLY REGISTERED
AND LICENSED AS R QUIR BY LOS ANGELES COUNTY DISCONNECT PLUG AND
NO/ORASATE OF C FOR A 0 H I AM THE LEGAL OWN- ABANDON HOUSE SEWER
OF THE A RISE E ID NTIAL PROPE BACKFILL SEPTIC TANKS
SIGNATURE T(S)[] CESSPOOLS[
OF PERMITTEE.
70A642D S&E 663 4/54
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