HomeMy Public PortalAbout5134 MCCLINTOCK AVE_Sewer__ DEPASTMLN'1' OF COUNTY ENGDn= = SEWER--c-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS.ANGELES 7 c[ 7^
WILLIAM J. FOX, COUNTY ENGINEER I ILDING
ADDRESS L r Z LACL�l1/1 C7 G
FOR APP (CANT T ILL IN LOCALITY 'L ,/L!D/lfTl
BUILDING NEAREST
ADDRESS L /� CROSS ST.
LOCALITY - DISTRICT NO. Ready for Inspection �P�ERMIT NO..
NEAREST 3 /eVgs
CROSS ST. ++ RECEIVED BY `DATE +gIS�SU+EED BY DATE
OWNER ,��7 as 1+/6
MAIL � ��IiL(J�
MAILADDRESS USEZQNE OCCUPANCY MAP
�,../ BK PG �
CITY TEL.NO. Roy
CONTRACTORCaliferni3 Sewer Const.Co. ,/ '
C0.IMP.NO.
ADDRESS 1317 Colegrove Ave.
JOB N .
CITY Montebello TEL.NO.'""
g� TRUNK)pm
IT NO.
REGISTRATION N0.104445 S ®"COUNTY ,r
ROAD PERMITLEGAL
O+r fl
DESCRIPTION LOT NO. / `� 16 STATE ENCROACH T II + I Q
BLOCK TRACT PERMIT NO.INDUSTRIALiii 1�1�T
.OF BLDG8. WASTE APPROVAL
SIZE OF LOT �4, NONOW ON LOT GES ,a
USE Dr
BUILDINGS CONNECTION CHAR EE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO l REIMBURSE T FEE
PUBLICSEWER a $. 3.50 REG ifixANO. I DATE BY
HOUSE 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 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD. 2.00 STATION DEPTH
SPECIAL CONDITIONS ONLY 2.00
* ' . / +YIANHDL,6EF,EREftNCE
Y. TYPE 0 CURB E7CTIONPP.L�Rl' M.L.TOHP.LOMj'd
OWNERS FPERMIT i 1 00
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HER IN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P BLIC SEWER
SIGNED THI! DAY OF—,?z4-V- 19-= NEW HOUSE SEWER Dig
CONNECT ADDITIONAL
OWNERS AEN ���_ '"/� �"1 � BUILDING OR.WORK
ADDRESS J.f' �" _r -�1� jCr. i'T +^ _ SEPTICTANK,SEEP..PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL❑
CATION AND STATE THAT THE ABOVE18 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/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF MDESCRI
OR THA 1 AM THE LEGAL OWN- . ABANDON HOUSE SEWER
ER OF THE ABOD RE DENTIAL PROPERTY. BACKFILL SEPTIC TANKSSIGNATURESEEP.PIT(S)[] CESSPOOLSOFPERMITTE _ _.-_. ' L�
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