HomeMy Public PortalAbout5208 MCCLINTOCK AVE_Sewer__ DOF COUNTY ENGINEER. -1� SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER J I NO
ADDRESS
= ADDRESS
FOR APPLICANT�TJO/ FrIILLL IN `' LOCALITYILDING
NEAEST
ADDRESS J„�[> !I'JI�i'�A.IG�U 11�i� `I CROSS ST.
LOCALITY � %fY� y - J'f � +� )00 . DISTRICT Nom. Ready for Inspection PERMIT NO.
O. c
NEAREST pyj�/r / �/, J
CROSS ST. .1:, �� Rlwiy'f ILl V +
��,' "� ��// �!� / : �{S a D.}E�GEIVED BY DATE i UE BY DATE
OWNER P!�/i r �!'S s //i" dy
MAILJ_� %�/li!!, ,f1 � 7�i ,/J'� ,� • r+ �'�`�
ADDRESS,, �� U �NE OCCUPANCY BK MAP P8
CITY /J7/TELRO. �O S'"'�yl�jr _fT oOD I � wbv
CONTRACTOR . I, i Jn [y AA CO.IMP.NO. r
ADDRESS ;%'s -
JOB.N0. � •-,�
CITY TELAO. TRUNK PERMIT 0. T -
STATE
REGISTRATION NO. B COUNTY 'ROAD PERMIT N0.
DESCRIP710N LOT NO. �f STATE ENCROACHME TY ,
PERMIT NO. n,
BLOCK TRACT INDUSTRIAL. �y 67r
WASTE APPROVAL
SIZE OF LOTjra x 7 NO.OF BLDGS.
NOW ON LOT
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE \
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER ® 111 8.50 -RECEIPT NO. I DATE �I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0. I DATE I
ALTER OR REPAIR EXISTING B.
_SEWER OR DISPOSAL SYSTEM 1.00
_ ABAND
ND OR DISPOSAL DON ECT ANDYSTEM SEWER 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR / 1
PITS AND/OR DRAINFIELD 2.00 STATION C-11.17 DEPTH (�
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00ANHOLE BE
k//(4' X UPPER tom"
TYPE OF CON CTI0�1 LENGTH FROM
OWNERS PERMIT $ 1 Y. CURB !! M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 010
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED �
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVAL$/r INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS. DAY OF Iq__ NEW HOUSE SEWERJy �f i 77
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.___.�._._..___.._._.._.__��..._�. r�__.�. _ BUILDING OR WORK
"SEPTIC TANK,SEEP.PIT(S)
ADDRESS_---_.-_. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I'NAVE.READ'THIS APPLI- CESSPOOL 0 DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
13
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR.SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED DISCONNECT PLUG AND
A'ND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE S EWER
AND STATE OF CALIFORNIA OR THAT:_1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPuERTY. r BACKFILL SEPTIC TANKS /��
SIGNATURE. SEEP.PIT(S)'[]. CESSPOOLS P�� �-
OF PERMITTEE• '-�� f.�liGli� ✓.✓r?/e "r�0-' '
7GA642D S&E 668 4/54 +