HomeMy Public PortalAbout5212 MCCLINTOCK AVE_Sewer__ DEPARTMENT OF 00II1= MGIN= SEWER-SEWAGE DISPOSAL 1
,DIVISION OF BUILDING AND SAFETY
COW= OF LOS " PERMIT APPLICATION"G="
i WILLIAM J. FOX. COUNTY ENGINEER I ADDRESS 3Z Z G
BUILDIN
FOR APPLICANT TO FILL IN LOCALITY n
BUILDINQ �� l C- /t4)ToG CR08S ST
ADDRESS /i� 6. 1
LOCALITY �-^ i DISTRICT N0. Ready for Inapeotion PERMIT NO.
NEAREST 9 ���(� S
CRO88 ST. �EE Z'
VED<$Y DATE II SUE BY DATE
OWNER 0. a2l;
ADDRESS USffZONE OCCUPANCY BK MAP.
CITY /�L TELAO. �-• _
�'G'D A
0
CONTRACTOR'�'8, � . I q pb VI0S CO.IMP.NO.
ADDRESS a-7 Af 3 LV-ALM &6-, i JOB NO.
CITY �ON+1, TEL.NO'-4=-o qa'q(.f RINK PERMIT NO.
STATE ,
REGISTRATION NO. ) 4,3'7.8`7 ROAD P RE MI•T`NO.
LEGAL
DESCRIPTION LOT NO. 6 v STATE ENCROACHMENT
PERMIT NO. �..
BLOCK TRACT - 13394 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT �� K l 16 S N0. O BLDGS. ' 8�
SE OF �j NOW ON LOT CHARGE
BU'1 DINGS' A!c—S ® CONNECTI/TI CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER S 8.60 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00 _� I
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_WORK TO HOUSE SEWER. 1.00
ALTER OR REPAIR EXISTING NO. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC
ITS AND/OR,DRAINFGELDT OR 2.00
STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 44 a N MANN, E'RffERENCE
TYP.OF CONNECTIONGTH FROM
a
OWNERS PERMIT ; 11 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE S"'D
H
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 DAY OF D -.192_-T NEW HOUSE SEWERj��j,�,�_
OWNER GR CONNECT ADDITIONAL
OWNERS AU T_ - BUILDING OR WORK
ADDRESS. AND/OR GRAINFIELD PIT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] 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 DISP08AL SYSTEM
1 HEREBY CERTIFY THAT 1 AN PROPERLY RE TERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELS OUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT -M THE L AL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED' REST TIAL PR MY. BACKFILL SEPTIC TANKS
SIGNATURE P SEEP.PI.T(S)0'CESSPOOLS
OF PERMITTEE7-1
76A642D S&E 663 4 �.