HomeMy Public PortalAbout5226 MCCLINTOCK AVE_Sewer__ DOF COUNTY ENGINE= SEWER—SEWAGE DISPOSAL, 1
DIVISION OF BUMDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENOINEtm I ADDRESS
FOR APPLICANT TO FILL IN LOCALITY !"'!
BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY / DISTRICT Nd. Ready for Inspeetlon NEAREST — I PERMIT NO.
CROSS ST. y,:(�.iv 1�= -� ,
q� n RECEIVED BY DATE I ISSUED BYA�_
OWNER
MAIL �'� ° r USE ZONE OCCUPANCV MAP
BK PG
ADDRESS `�' r, �RsC !._ Q.;�'ti ft C 1,.i
CITY TELNO. �S �' 7-
CONTRACTOR •� rw �r_ys'
CO.IMP.NO. /� �/ •�
ADDRESS 'a s' R•^�+
.4a -.rr JOB NO.
CITY-'� �f TEL.NO. o j:y,.3 TRUNK PERMIT N0.STATE
REGISTRATIO NO. ® COUNTY ROAD PERMIT NO.
LEGAL / STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT J�� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT ��� NNOW ON LOTS ® CHARGES
USE DCONNECTI ABBE FEE
BUILDINGS ,c'—�',rF�'•t (` '
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER G? $ 8.50 RECEIPT NO. TE I 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 BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR ® a
PITS AND/OR DRAINFIELD 2.00 STATION 9 &,ol-7 A DEPTH
CESSPOOL—DRY W ELL
SPECIAL CONDITIONS ONLY 2.00 , :t v �j!/ MANHOLE REFERENCE L OW
TYPE OF CONNECTION LENGTH FROM e,+
OWNERS PERMIT = 1 00 Y. CURB P.L. Z11M.L.TO P.L. `4 t
AUTHORIZATION TOTAL FEE ' so
1 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 f
SIGNED THISOF 19_.__ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT-..__._.^.....___ BUILDING OR WORK
......._.....__.._ �....______ ,, __, SEPTIC TANK,SEEP.PIT(S)
ADDRESS.._.
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 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 DISPOSAL SYSTEM
A ID%OR LICESED CERTIFY EQUIRETHAT I D BYPLOS EANGELLY ES ICOUNTY
AID/,QR DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVZDIRESIDENT'4Wk PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S) CESSPOOLS s + '•
SIGNATURE
OF PERMITTE
76AG42D S&E 663 4/54
'BASAEb APPLICATION:E808 f]-5'7 t=C)R PERMIT
1
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION B
UILDING
J®HLA
N A. MBIE, County Engineer ADDRESS r
CZY
ASSATT D. GILIFFIN. Supt of Building CALITY ° j�dc' P1
FOR APPLICANT TO FILL IN oss sr. " --
LEGAL
DESCRIPTIONOWNER
LOT NO, ,.
� E,.idr,.,Ei ...d ✓(.1. "`
<f z �'ab MAIL
BLOCK TRACT rt
ADDRESS
NO.OF BLD4S. _t
SIZE OF LOT ,p NOW ON LOT'S CITY ">4}4_-€;y t T NO.
USE OF
BUI DINGSs"+` �,3%�:` / _F..' C-fA �,� '`�k
�a DISTRICT NO. GROUP MAP
CONTRACTOR ? s 1 _,; PG
ADDRESS " aeff CONNECTION DATA
- ----
CITY r✓t i w4 a `"TEL.N0. r qr� /1111 STATION DEPTH
STATE MANHOLE REFERENCE UPPER
REGISTRATION NO. H COUNTY LOWER
NO. _ DESCRIPTION OF WORK FEE _..--
�-HOUSE SEWER CONNECTING TOPU5 `�., _.._ ,� _ '. ✓ ,, �}�", =d .�
SEPC-
HOUSE
CC r SEWER $3.50 TYPE OF CONNECTION LENGTH FROM
TANK,SEEPAGE PIT OR YCURB P.L. M.L.TO P.L.
PITS ANDr'OR DRAINFIELD @ $3.00 -Y. _
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPDOL,DRYWELL,MANHOLE @ $2,00
HOUSE SEWER CONNECTING.TO P,C. NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR _ -
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE -
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
I PERMIT NO.
t -
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PERMIT $ 1 00 CONNECTION CHARGE FEE
AUTHORIZATION : TOTAL FEE (mak 1 REIMBURSEMENT FEE
[ HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRILED EXISTING DWELLING APPROVALS DATE (INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER. --
SIGNED THIS ✓ (DAY OF - 19'Y NEW HOUSE SEWER _�—I',' -------
OWNER OR CONNECT ADDITIONAL I -
OWNERS AGENT �� - �I -�'" - 11!_LDI NG OR WORK I
ADDRESS r Z !-y^ SEPTIC TANK,SEEP,PIT(S)
-
- - �r � s I - AND/ORDRAINFIELD
I HEREBY A.CKNO LEDGE THAT I HAVE READ THIS APPLICATION -
AND STATE THAT THE ABOVE. IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYW£LL El
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER 612 i HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR. —SEWAGE DISPOSAL SYSTEM-- ------
LICENSED AS REQUIRED $Y DS ANGELES COUNTY AND.STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AM THE LEGAL,YGWNER OF (THE ABOVE ABANDON HOUSE SEWER _
DESCRIBED RESIDENT]f PROP£RTYr- '7f- BACKFILL SEPTIC
SIGNATURE ll ,r {! SEEP. PIT(s) El CESSPOOLS ❑
OF PERMITTEE J
9R VALMATIOI�3"_ ROBERT" A. WOOD
CK. K.0. ?'CASa, SUPERVISING MECHANICAL ENGINEER
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