HomeMy Public PortalAbout5125 MCCLINTOCK AVE_Sewer__ DEOF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY , , = PERMIT APPLICATION
COUNTY OF LOS ANGELES ,fit"
WILLIAM J. FOX, COUNTY ENDINEll +1,. BUILDING / p.+
I ADDRESS �! ,7- til �L°
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS hT2bile�;=i1Tt $L QVi�- CROS88T. (✓ Y—U°
LOCALITY �6 2r t DISTRACT NO. Ready for lospectlon PERMIT NO. c
NEAREST F ,rd G7 3 S
CROSS ST. Grand RECEIVED BY DATE I ISSUED BY - DATE
OWNER D. A. Thomas ��.- L• �T �6, ;'' ` , '^
MAIL
ADDRESS same UaFzn E OCCUPANCY ( BK MAP PG
CITY same TEL.NO. $�� • i -e `� I
CONTRACTOR j OhIl A. BiSkovich
CO.IMP.N0.
ADDRESS P174-3 Lee eve. JO NO.
CITY hl Monte TEL.NO-Fo. 88469 TRUNK RMIT NO.
TE
REGISTRATION N0. 3
,-125 1.,89 /� ROAD PERMI 0.LEGAL -
j
DESCRIPTION LOT N0. �i j D �Fjo�Y! � OP Ql/ STATE ENCROAC NT
5 PERMIT N0.
BLOCK TRACT �I WASTE APPROVAL
SIZE OF LOT '/�� ®EG'�--NOW ON LOTS CH ILGES
USE BUILDINGS �S mak' [CO "14¢.Q CONNECTION RCE FEE
NO. DESC IPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBU MENT FEE
PUBLIC SEWER G $ 3.60 ® CEIPT NO. I DATE 1Y
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM I.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 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC
ITS AND/011 DRAINFGELPDIT OR 2.00f� �.
STATIONy `s DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / MANHOLE REFERENCE r -
OWER
Y. TYPE OFCONNECTIONECTIO P.L. !� LENGTH L.TO P.L.OM a f
OWNERS PERMIT ; 1 00
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGN URE DATE
DWELLING TO THE PUBLIC SEWER rr�
SIGNED THIY OF2� 1 NEW HOUSE SEWER
OWNER OR f ��; CONNECT ADDITIONAL
OWNERS AGE."
'� BUILDING OR WORK
ADDRE ..... I._ _„ _ 1 SEPTIC TANKISEEP.PIT(S)
AND/OR DRANFIELD
I IO
CATIHE
OREVICKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL
N 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. SEWAt;E DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTE---
A
ED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
ANNOTATE OF LIFORNIA OR THAT I AM THE EGAL
OWN- ABANDON HOUSE SEWER '
ER OF THE ABO DESC IBED RESIDENTIALPERTY. BACKFILL SEPTIC TANKS
SIGNATURE ® SEEP.PIT(S)[] CESSPOOLS .',,;
OF PERMITTEE. '
76A642D S&E 663 4/64 r�