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HomeMy Public PortalAbout5318 MCCULLOCH AVE_Sewer__ 'rbA6/2D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FA DING JOAN A, LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt of Building �a LIT'1' �*p/y�n 7� p T/r y� .�s �+ FILL py'p NEAREST FOR R A 1xICA � L ,t,O J:ILL 5 T _-?*�'�-•+j''sR-.__ _-_ - LEC'AL I"F_'SCF fTlO .OT NO. OWNER ,.id' d ( ,� "�r*• ,,.a.,�• MAIL- 7 O r T -ADDRESS NO. O'= BLDGS. - :742:E. ^F LO7 NOW ON LOT CITY— Th_L...NO. U £ l Bi.IL, NO. GROUP MAP PROCESSED Y BK f aF CONTRACTOR_ _ o' ArDRE.Ss _ _ 'p ` 4 ^,';:s--� CONNECT.ION-DATA ------ —, C C'rY_ _ - 1 L NO.j +4r ` NATION .1 '."`Cry •Ce -_- UFP7S-i— a ryd d STATE , F- UPF ER R_GIS ATOM NO r T6HOL RFFFREFERENCE �' fi .. ,! -- '+,at� jMA COUNTY 2:; t'1v. Or.�tiCYd f'PY Ot OF WORK F E -- TYPE OF Cb Np �7`I N LENG 4 FROM HOJ S'EW Eii CO NN ECT7 N:G 70 -_. Y w- y, a L A9.L TO P.L. - PU BL it•^SEWER. f 0p'� $5.OD f- _. r .,E0.• P.C.NO _._ U E IC.TA�K BE E:P AGE Y1TOR I PITS AND/OR DRA.INFIE D @ $10.00 CO' MP *!O JOB NO _.. -__ / _�.. w� FIOLSF SEWER ONN C7 I+.TO TRUNK PERMIT NO ROAD PERMIT NO. G °� 0 RRI\A u ,ISPOS [ SYSTEM tui $3.00 -.�.._--. . C' F _.- __ -- ...-� R.F_,...O RD. INS TF n0. I DATE. CONNECT T aQ'D lTIONAL BLDG.OR -- T AF'F'IDAVIT NAl:E� EA"EM EMT f- 1- dORK.TOHf S SEWER @ $3-00 � OVERFLOW SEEPAGE P17' DFA IN F IELO _ __ EXTN_CE, SPOU!_.DRY MANHOLE $ 00 HWY OR ST,WIDENING -�KILTER RE At t OR A Alj(0(�N HOUSE � E NFR OR DI AOS gE'5TE M` L 43 00 -..., ., ..- STATE ENCROACHMENT j `t. p.✓A I PERMIT NO. IN')US'rRiAL -�_--- WASTE APPROVAL I'* CHARG.ES O VINER S PERhIIT _2 amu. --- -- — — —— -— --— — AUTHORIZATION AO+jt TQTAL FI N7 ONNEt TI TN CFIAP.GTFE e, IHAVE AT THIS DA�rE A CONTRACT WITH THE, HEREIN NAMED CON REIMBURSEMENTFEE TR 6,2TR TOCONNECT THE.. ABOVE DESCRIBED EXISTING DWELLI.NG. TO TF,_ PU6LIC SE'YV.1, APPROVALS ' DATE: T INSPECTOR'S SIGNATURE SIGNED THIS___DAY OF�^.__._ OWNER OP f y NEN HOUSE SEWER A,ENT-_ OWNERS � 7. -�. s—.T..__.._.___..—. C ONN EC'T ADDI'Y'1 O.NAL ADDRESS BU.LD!NG OR WORK SEPTIC rANA SEEP,F'1" S - I 1 HtREBY A KNOYV LEDGE THAT t HAVE READ THIS APPLICAI ION AND/OR DRAINFIE�D ( } ` qNR SEATS TH .7' THE ;.BOYS 7-S' CORRECT AND AGREE TO COMPLY WITH .ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 1 PLUMBING AND SEWERS. CESSPOOL n DRYWELL ;. HEREBY CERTIFY THAT 1 AM PROPERLY REf;iSTERED AND/OR ALTER,REPAIR,SEWER 0 LIC.ENSEO AS REQUIRE:C. RV 1-0ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM f ALit"�'75"J!A OR Th AT i 4M THE RAL LEGAL OWNER i? AND INTEND 7ODISCONNECT nI 3'L U,,-AND ` R£S.IDE N, THE ABOV DE CRJ BcD RESSTOENTIAL PROPERTY. ABANDON OUSE SEWER S;CNA J12''. � = BA KF1LL.SEPTIC Taiu,iS OF PESt,..iTTE.E._ - Al_.__.-.__-___ _ -- -- SEEP.FIT IS' ❑ CESSPOOLS. I VAI.IDATIO - ROBERT A. WOOD SUPERVISING MECHANICAL, ENGINEER M.O. CASH Li 8 9 Zjlr 5»,w AUG 141 1 D 2 5. C) V� v1-4,0 >c E808 10-02 re,A6420 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BU I LD I NGr, JOHN A. LAMBIE County Engineer ADDRESS WILLIAM A. IENSEif, Supt of Building LOCALITY EA CROSS ST REST — FOR APPLICANT TO FILL IN r 14 R AIL F 311 ING I.'L7D ADDRESS L_a CAL�y Nr A ADDRESS'LO A,!'T A [c)"INE A NO, OF SLOGS, ppp _SIZE 05 LOT NOW ON LOT CITY T'EL. NO. US L OF BWL.DiNGIS DiSTRUCT NO, GROUP MAP PFW"SSt:D BY BK PG �'J 7 c©1T T f ADDREW,eCONNECTION DATA SS t TEL NO. S WTiON CITY DEPTH UPPER STATE COUNT REGICTSA',)ON NO, gr*"r C-e -A---L.REIEREN— NO. rD r 6,m FvT 16 Iq OF, nk C)R K E TY_p0NNE-TIC(V 0,1�.C, LENGTH FROM r�!q Y. M TO PA_ i HOUSE SEWER CONNECTING 70, 0 i t F-JBLIC SFWER SEPTIC TANK,SEEPA6i_�iT_6�z PITS ANO/OR DRAINFiELD $10.0a CO.IMP� NO. JOB NO. MOUSE SEWER CONNECTING' TO PERMIT NO. ROAD PERMIT N( ',,>�Z� PRI APE DISPOSAL SYSTEM @ S300 0 . CONNE�T ADDITiONAL.BLDG,OR WORK To HOUSE SEWER @ $300 DATE Uj -GE PIT,DRAiNFIELD — 6VEFWLOW SE�PA V) EXTN.,CESSPQOL,DRYWrLL,MANHQLF $5 00 z ALTER,REPAIR - - HWY.OF?ST.WIDENING EWER ORDjsPos.AL_Sys�,_30_ $3.00 STATE ENCROACHMENT PERMIT NO, tk---#- INDUSTRIAL WASTE APPROVAL CHARGES PERMIT --------- OWNEIrs TOTAI FEE 51" CONNFC'1iON CHARGE FEE AUTHORIZATION I HAVE AT THI' DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE C T,'A%"" R TO CO 4NECT THE ,ASSY F' DESCRIBED EXISTING DWFLA.jL4.E, —APPROVALS NSPF� TO THE. PUBL!C SFIVER. DATE' -TOR'9 SIGNATURE a1 CGN F.,GT. -----------THfS-----DAY OF OWNER ORNEW HOU9E SEWER AGE F,JY T CONNECl ADDITIONAL, ILDING OR WOR ADDRESS K.SEEP_PIT(S) SEPTIC TAN I HEREBY ACKNOWLEDGE THAT I HAVE. READ THIS APPLICATION ANO/OR DRA;NFIELr, N 0 STATC THAT THE ABOVE i, CORRECT AND AGREE 'TO COM-LY --. WITH A[MB I- COUN I Y ORDINANCT,::S AND STATE LAWS REGULATING PLU '.ING APVD SEWERS. CESSPOOL 01 ORYWELL I HERERY CERTIFY THAT IAM PROPERLY REGISTERED AND/OR ALTER REPAIR,SEWER OR IC ENGrD AS REQUIRED BY LOS ANGLES COUNTY AND STATE Of' SEWAGE DISP05AL SYSTEM CI-IFORN A E OR THAT I AM THF.' LEGALOWNER OF, AND INTEND 10 DiSCONNFCT PLUG AND RESIDE !N, TPABO.',- -SCRIBED RESIDENTIAL PROPERTY. ABANDON H OUSE:SEWER SIGNATURE CE m I TT SIFPTIC TANKS 3 . IT(S) CESSPOOLS VA DATION­ ROBERT A. WOOD CK. M.0. CASH SUPERVISING MECHANICAL. ENGINEER L -a-4'iQ RIGG 14 1 0 D 7.0 0-