HomeMy Public PortalAbout5119 MCCLINTOCK AVE_Sewer__ 5a a>;E-65as aa.�� .APPLICATION FOR PERMIT -
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
jO!gN A. LAMBIE, COUNTY ENGINEER ADDRESS ---
.��. CASSATT O. GRIFFIN. SUP'TorBUILDING LOCALITY
" RES
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FORAPPLICANT TO PILL IN CROSS ST. __.
LEGAL fl; '- ---------- OWNER a- j — -------_
_D_FS.CRIPTION LOT NC _---
MAIL
BLOCK — TRACT ADDRESS '
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N0,OF BLUES.
SELF OF LOT - '� ; ?; NOW ON LOT-- ;,,,;..-,.. CITY/a,, vr¢,._z s ;.d`fEL NOy��.J �
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CONTRACTOR ir✓ ' ----- -- -- --- - ?� -- j-----
ADDRESS ✓ .r�, r - .–�--� CONNECTION DATA� --- _-
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a" ✓y ^. / ,) STATION ,tea 5 z._Jas .. DEPTH _
CITY 3- L N0.
--- �;--';=-- -- - ---`-'' �- -- MANHOLE REFERENCE .UPPER
STATE_
REG:STkAT1N NO, - (i COUNTY
no. bEESCRIPTION OF WORK— FEF
HOUSE-—
SEWER CONNECTING r0 --- TYPE OF CONNECTION - LENGTH FROM
PUBLIC SEWER Cn) -3 Y• _.._CURIE P T _59 L. 70 P LT'�y`---- - --
? SEPTIC TANK SEEPAGE PIT OR
PITS AND OR Lk.AiHFIE:LD Ca $3.00
j OVERFLOW SEEPAGE PIT, DRAIN€IELD --II -- - P C NO,
EXTN.,CE'SSPOOL,DRYNFLt.,MANHOLE S 2.001 I CO IMP NO. --` � JOB NO,
ROUSE SEWER CONNECTING TO -- -- ------- -. _._. -- -----..�..---
` PRIVATE DISPOSAL SYSTEM (e TRUNK PERMtT NO ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR ----------- —'----.- . .
STATE ENCROACnME"dT
_- 1^IORK TCS HOUSE SE1"rR i.0u PERMIT NO,
ALTER.,REPAIR OR ABANDON HOUSE
_SEWER OR DISPOSAL SYS EP, �_ s 1.00 f INDUSTRIAL
WASTE APPROVAL
.---1�..�_ � ---------
CHARGES
4 --- .---- ._.--�-,r--- CONNECTION CHARGE FEE -
CaNER"� PERMIT ` — -- ---------- - --
_ -- J�1 OO— REIMBURSEMENT FEE
AUTNCSB.IZATION TOTAL FEE --
APPROVALS iA."iE SFECTOrc'SSIGFJATUit'
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- _--_-. ..__.---- —_------
TRACTOR TO CONN-ECT THE ABOVE DESCRIBED EMS:fiNG DWELLING -
TO THE PUBLIC SEWER. -- ---- NEW HQUtiF-SEWER I.
GINNED THIS--.---DAY OF I9____. ,.1 -___---- ---.-_
CONNECT ADL[. ANAL
OWNER OR BUILDING' OR WORK
OWNERS AG•ENT_____. —,---- -------------- r---.�..-- .._.___.'_--
SEPTIC TANK,SEEP, PIT(S) I
ADDRESS._ AND/OR DR INF1E.LD I
I HEREBY ACKNOWLEDGE THAT ! HAVE READ THIS APPL,CAT30N CESSPOOL[] DRYWELLI_JAND STATE. THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
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 DISCONNECT PLUG AND
LICENSED AS RE' UiRED BY WS ANC- LES COUNTY AND STATE OF ABANDON HOUSE f
CALIFORNIA OR A!, -04 THE GAL OWN%R OF THE A13OVE ABANDON --- E SEW
DESCRIBED RESIDy�T'!'AL PROPERTY ,r f BAC KFILLSEPTIC.TANKS
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SIGNATURE �� I SEEP,PIT(s) L,_CESSPOOLS I�j
OF PERMITT6 ...};' Est%i : 1 ✓ 3r- "✓yyl
I i
IOHN A. LAMBIE, COUNry ENGINEER VALIDATION ROBERT A. WOOD, CHIEF" PLEIG. INSPECTOR
0r�, �CC{ASH M .rte /( 8g
450
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