HomeMy Public PortalAbout5241 MCCLINTOCK AVE_Sewer__ . DEPARTB F.NT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSA133 S f 1
DIVISION OF BUILDING AND SAFETY
�� COUNTY OF LOS ANGEI.E
PERMIT APPLICATION
S
1 UILDING
WILLIAM J. FOX, 013UNTY ENGINEER I ADDRESS
FOR APPLICANT TO FILL .IN ,�
LOCALITY - ,
/' �+�� NEAREST V
ADDRESS `� t°r `7 lLC!�-.(� +'v� L'-i F�_ CROSS ST.
LOCALITY ~ �� DISTRI`NO. SERIAL NO. PERMIT NO. c
NEAREST �' A ,�7�J 9 `�
CROSS ST. r ,
RECEIVED BY Ready for Inspection DATEISSUED
OWNER���� .ls( tafllb � � ��-C•�',� �����.�T
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
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CITY 1� TEL.NO.
CONTRACTOR
t!alifornia s!+.tPP.m t!nnat-.--[ioa co.IMP.NO.
ADDRESS 1317 Colegrove. va_ JOB NN
CITY Montebello TEL.NO. Ni on 1—viin4a TRUNK P IT NO.
REGISTRATION NO. 104445 STATTY ROAD PERMIT
LEGAL / STATE ENCROAC ENT
DESCRIPTION LOT NO.B. PERMIT NO.
BLOCK Te T• INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 1 NO.OF BLOGS. a{YES
NOW ON LOT
US
LD NGS /�� �c� CONNECTION CHARGE FE
NO. DE CRIPTION OF WORK FEE
REIMBURSEMENT FE
HOUSE SEWER CONNECTING TO } N0. I DATE BY
PUBLICSEWER G $ 3.50 RECEIPT�`9, a )/�
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 PITS AND%OR DRAINFGELPIT OR 2.00
CESSPOOL—DRYWELL STATION DEPTH
B � �®
SPECIAL CONDITIONS ONLY 2.00 /a�� g� -MA UPP 115 FERENCE `L
TYPE OF CONNECTION /f ENGTH FROM �)
OWNERS PERMIT s 1 00 Y. CURB P.L. 6 M.L.TO P.L. a
AUTHORIZATION TOTAL FEE 1 &'13/)
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P LIC SEWER
SIGNED THIS_. ..DAY F _ _ 1 NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
.
OWNERS AGEN �r- ._ _ BUILDING OR WORK
ADDRESS........_._.` -- ----•• .�.. - SEPTIC TANK.SEEP.PIT(S)
- •-• AND/OR DRAINFIELD
1 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 DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERT BACKFILL SEPTIC TANKS _
SEEP.PIT(S)11 CESSPOOLS
SIGNATURE !�
OF PERMITTEs!. :�i��_.P.. ...{;r .. _ ._.. f)
76A642A 663 7/53 /�! _ �. i• f.
DEPARTNOENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL,
{DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FCX, CoUM'T'Y EHommm BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING pol NEAREST
ADDRESS 14 ril h e— /&7—&L CROSS ST.
LOCALITY DISTRICT N0. -...;w�# �vrs4aYYfsti PERMIT N0.
NEAREST C
CROSS ST. - -----
RECEIVED BY DATE I ISSUED 13Y DATE
OWNER y
MAIL
aJ OGCUPA
ADDRESS USE ZONE/ ( NCY MAP
BK P8
CITY TELNO. ' If
CONTRACTORR�f�rDr S� Qn
dfL or n cfI.I1..- i3 .-m. ,�, CO.IMP.NO.
ADDRESS /,317 g of orad Ave, JOB NO.
CITYGia �t4eEL.MO. � ��{yrs#�t TRUNK PERMIT NO.
STATE
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO., PERMIT NO.
BLOCK TRACT INDUSTRIAL
s WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES,
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO< DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER IN $ 3^.50 RECEIPT NO. + DATE I BY
HOUSE SEWER CONNECTING TO 1
PRIVATE DISPOSAL SYSTEM 1._00
CONNECT ADDITIONAL BLDG.OR �. EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO-, DATE I SY
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/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE '.
UPPER LOWER
TYPE OF CONNECTION LENGTH F110M
OWNERS PERMIT 1 00 Y. CURB P.L. M.L.TO P.L
AUTHORIZATION TOTAL FEE
—
I14AVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER 1
SIGNED THIS DAY OF ✓ 1 ` NEW HOUSE SEWER
OWNER OR w_ y CONNECT ADDITIONAL
OWNERS AGENT . ... BUILDING OR WORK
ADORESEPTIC TANK,BEEP ITIS?
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLI- CESSPOOL[ DRYWELL E
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
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OFLCALIF !A THAT 1AM THE LEGAL OWN-
ER OF THE ABRIB R IUPENTIAL PROP * FILL SEPTIC TANKS
SEEP,PIT(S)❑ CESSPOOLS[]
SIGOF PERMITTEE .._
76.A642D S 4cE 663 4/64