HomeMy Public PortalAbout5322 MCCULLOCH AVE_Sewer__ (3A6
4.�A20 APPLICATION FOR PERMIT"
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL,
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION HOLDING
)OHM A. LAMBI£, County Engineer aurRFEs � "
WILLIAM R, 3ENSEN, Supt of Building LOCALITY �
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FOR A4?e-,
LICANT TO FILL� CR[)SS 5
E:SC l ;.t ? 9 OWNER ' — 5� +'K._
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NO. G` 5C ftlPl ON OP WORK FEE .TYPE OF CONNECTION LENGTH FROM
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OUSE SEN R CCN FI6�T NC 70 !
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PUBLIC SEWER $ DO 11 _.__ _ _.__ _ _
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C: t 10 0c f O IMF N':-4 _ - JOB NO q'`" `�
EP fG IANh SLEPAGC PIT OR
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PITS AND/JR DRAT Nf IEL❑ $ � � -�. -
t OU SFV. R CCIN NEC Y!NG O ...- TRUNK PERMIT NO ROAD PERMtr NO,
PRIVA-TE DISPOSAL SY 'IEM $3.00
O�.NC-T ADDtTIONAL BLDG OF 4.FFtDAV17 WAIVER, EASEMENT REGORD.INSTR.NO. BATE
WORKONOU SE EWER C $ 00
OVERFLOW SEtPA:yEPiT,DRAINFIELD --
1 EXTN:CE SPOOL,DRYWELL.MANHOLE @ s5,00 _�_ st V✓�, OR ST.WIDENING
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ALT.fUi-Rb PAT-R 0R 48?I hIQ O!+1 Holl S'E..
SEWER OR DISPOSAL SYSTEM � 53.00
-_-_� TATE ENCROACHMENT
'PERMIT NO.
WASTE APPROVAL.
OVVNER'S P', RM _21 00CHARGES -
AUTHOPUATION TOTAL FEE S; 1 ,f7 ONNF TION CHARGE SEE
REiMBUR EMENT FEE
'r':AVr AT TH•S DATE: .1, CONTRACT` WITH 'THE' HEREIN NAMED CON
"PA;,TOR TO CONNECT THE ABOVE DESCRIBED EX!ST',Na DWELLING --_.-._._..___- ,-
:O THE. IUS IC SEWER. .FI'F�1VALS. DATE I;NSPECTOR'S SIGNATURF:
S,L;NED THHG _.e_DAY OF Y—� —i�3--- ---- -- ------- - -- ------�. :--- ------ ----
OWNER ORT , ,,.rF�' NEIN HU3 E SEWER
OWNERS AGs.N7a=--____ . CONNECT,ADD!T'}ONAL
BUILDING OR WORK i
SEPTIC TANK,SEEP F TI,S)
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y' }HERESY ACKNOWLEDGE uVLE DGE THAT I HAVE READ THIS APPLICATION AND;�OR DRAI NF'.'��D I '
AND CORRECT AND AGREE TO COMPLY -
STATE` THAT THE ABOVE !S ____ __�___�_____._-__--_.,�_ ...___._, ..____.___._
MI.T, ALL �C.'O NTY ORDINANCES AND STATE LAWS REGULATING
}i UMBING AND CESSPOOL DRY WELL SEWERS.
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I HEREBY CERTIFY THAT AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSFO AS REQUIRED BY LOS ANGLES' COUNTY AND STATE. OF SEWAGE DISPOSAL SYSTEM
CALlFOFiNiA PH THAT I A 1 THE LEGAL OWPi£R i�F, AICD lNTE:Np 'TIO - '--- '----- - -'-'-'---" - ---'-------
515 ONN ECT PLU A}VD -"-`----_-
RF_.SIDE IN, THE ABI' E FSCRI BED RESIDENTIAL PROPERTY.
ABANDON HOUSE SEWER
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BACKFILL
SEPTI-.-___
GNATURE I' L :'TANKS L-1
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- --- - --` ------ SEEP,PIT S) CESSPOOLS
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VALIDATION ROBERT A. WOOD
CK. M.0 CASH
SUPERVISING AIECHAN!CAL ENGINEER
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