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HomeMy Public PortalAbout5332-5334-5836-5338 MCCULLOCH AVE_Sewer__ e��, ��• '� ON 6420`. EdOE p-7/76 k � � k I BPLOC 0 FOR �GVL® � tlP�i� ®QSP®79L u . COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FOR APPLICANT TO F 11 �Kp DISTRICT NO. GROUP BK MAP PS 'ARD SSED BY BUILDING r /09-Ir \.9!/N 6 FEW b + CONIUECTIOPT DATA LOCALITY• NEAREST STATION. DEPTH. CROSS ST, _ 11 UPPER MANHOLE REFERENCE - OWNER OF CONNECTION (JV' LENGTH FROM 1 MAIL. CURB P.L. M.L.TO P.L. ADDRESS P.C.NO. r CO.IMP.NO. JOB NO.- CITY -TEL. NO. LEGAL TRUNK PERMIT NO. ROAD PERMIT NO DESCRIPTION LOT NO. AFFIDAVIT 01AIVIER EASRMENT RECORD.1NSTR.NO. DATE BLOCK _ TRACT 13 -4,Z NO. OF SLOGS. - .SIZE OF 'LOT NOW ON LOT HWY.OR ST.WIDENING USE OF STATE ENCROACHMENT BUILDINGS PERMIT NO. CONTRACTOR ✓ INDUSTRIAL�. JAN a _ CoWASTE APPROVAL ADDRESS CHARGES I. CITYOqk_c, TEL. NO. - STATE ` LIC vat _ E .�� •y LICENSE. N.O, C1J16517— �f �v I90. DESCRIPTION F WORK FEE APPROVA S DATE INSPECTOR'S SIGNATURE.,, !� / HOUSE SEWER CONNECTING TO �. PUBLIC SEWER NEW HOUSE SEWER SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR DRAINFIELD CONNECT ADDITIONAL HOUSE SEWER CONNECTING TO BUILDING OR WORK PRIVATE DISPOSAL SYSTEM SEPTIC.TANK.SEEP,PIT(S) �. .: CONNECT ADDITIONAL BLDG.ORS. AND/OR DRAINFIELD WORK TO HOUSE.SEWER :OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL ❑ DRYWELL ❑ ESSPOOL.DRYWELL..MANHOLE @ ALTER,REPAfR.SEWER OR R SEWAGEDISPOSAL:SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS .❑ 'r 'SEEP.PIT(S) ❑ 'CESSPOOLS ❑ O.WMWS Issuance.Fee $ I ::: :......:, . ... •:.... . . , . , 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AUTHOBMATION. TOTAL FEE 1: AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO'COMPLY WITH ALL COUNTY ORDINANCES AND: STATE' LAWS REGULATING'+ I HAVE AT THIS DATE A.CONTRACT WITH THE HEREIN .N' ED CON- PLUMBING AND SEWERS. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING I HEREBY CERTIFY THAT- I AM PROPERLY REGISTERED AND/OR'. TO THE PUBLIC SEWER. - LICENSED AS' REQUIRED BY LOS ANGLES COUNTY AND STATE OF SIGNED THIS DAY OF 19_ CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF. AND.INTEND TO OWNER OR RESIDE IN. THE ABOVE. DESCRIBED RESIDENTIAL PROPERTY. OWNERS AGENT SI:GNAT.UREI OF PERMITTEE - / RC1'—• CIC i. _I�_ * 1. - _Y d•' P.:: _ _ _ - ON yICN V 1 y '� I� M.O. CASK 3 7 4 tijAN J1 I u 2 4.0 _ X, 'A c lGA.647p = C::E868 -'4f'7.9 APPLICATION FOR .PE:RMl U :j:;?--:�'y 6.-3 — Vo DER¢4iaTWi.EIVT OF COUNTY :EN,011415ER �UI!_DYMG.AND S�1F,EW 0M tOIV su:iLOIN. C : .. .. - .. �LxS'GA.4iT�Y _ .'.: '��•�ifs..��.:� � kF .� _' F®RAPP �9?_ pILARE67 i TO FILL 1:1�; rr MA.tL Ir . . �. i . ' BLOCK TRACT'- � VJ ••�'y�� .- - .- ADDRESS •�� �� .. �• „�°••�"."' S'IZ.E OF.L ." ... .t OW.'CN-'1.97'. .. p.m. . ..:tl :TEL, .NO; '. ...: �..�..._. USE OF' BUJLD�INOS Q'YS.TFi:.I6T�lTO_:�:106U:P � .�. Mk'P�� ..�.E;ESSE`Q�B,"Of` P.S -06 CITY ��FiONN ��.. .:,,x °.*`•4� '� :te="r"iT'EL. ND. ST.AT.E UiDPP$R t[cENsS.XtAr :M%6liI1aL�'.RF£RENC6. . ��. � �7' ..�"�:A�BFr - 7" � �� ��:.: ..moi�::���•� .. .1: WER} pity m D.E4CRI)?Tl0'N.. OF YM.R-K: .F .. .. TYI?<R,'t5P CONNEC7WtlV Li'Hii.TH,PRO.lG1 HO[J$'°Fa 5EWER Eg7NNECTi:N6'T1C - -- Y. :CURS P.L. .M;L.TO P:L.. gg :pU.BL}C:BEWER a.. SEPTIC,TANK,SERPAGE RI.T-OR - - PITS.�NAtoo 6RAUVI'Ei;C. � NI•Y D.CD � I:p1Pr Npa_ JOB N HCL'>l:E�` EWE.:PONS1'. G'T9 PRIVATE 6I6A05jA't,;SS.S;QD „�,.:.. .:• 7FIJN1c.I+ER:lu0:7''NO: R.O.ADPIirRIJINT':N17. . COMNE:GT AODITYCNAI,:B G.'OR .-. _ :A�€'f?IDA,VITWAIV.lA: lg8fiA1lf1T RECORD,FN8'TltN.C': D(C'I'p' - WC'R.1£TO.FIOUOS PEW,ER; moo - - .. .... OWRFL'•OWAFEP. INP. .L4._ - .AITER'. .89.D0- .:- .._- .. STATE NCNOACN MENTI 77V _ N!Atai}tkLE .' ?°�3MIT.FI�. ,'vlrl - D O 11I �-��-� �- � ���1NDU8T�kC1;Y►�_ . VIiVAL O CHARGES���py D .. ... ..._ _ .. - .. S 119007 C.NMEC7)O:t?I t#1�11RGE.:FEE; ;REIJA,BUR$LhNE.NT 1 .NAYS%lT'T�:F.1YS��QATE'._�A .CONSRIICT��WIT}N.�T}I.E:tlE#lfN NA�NjED.'C:�O:.N.= P.EE. .._. TRACTOR T..6 CONNECT TRE:ABOV,E DESCRIBED EXISTING DWELLING: - p-� l}��4-' TO.THE:PU�BLNC SEWER: 'AftM, 0 tl�LIlJ" DATE .'ITNSPEC'(Q0 -IGFI.'(-)RE Mr OF OWNEh6 Allot" -- - CONNECT-ACD4VONAL <N17'ILOFN6:.ORVVORK: .r ':�'a • :$EFT,I.C'TP.NK,.SEEP,'P..IT'($) ,C.. " •w I KeRvfw-.^"Now)-amGE "AT :t HA:'VEr IAE•gD 7'H 14 NRRLR.`.Sil;S.INlpl: ,. A7+.IG:XCR I;CINItl1T:1.Ri:Etip' { - .41.k 4 KNO '$,TATE':'r-HAY. THE. ABOVt.1$TrORREC'[.A'NO.AGREE. TO•CO A.L:V :. ... 1: ...- •.WWH A4,.L :COUNTY ©RDIE'S'NANCAND ATNT-9 I:iKL118 REGULATING 1 - ` - �r ;•}` `• PL'11M.BING AND SEWER5: C$SSPOOL, Q DRY1lY..l 1 HEREBY CERTIFY T.HA:7 1.. lid. PROPMLY .RE019TER /OR: gkTER.Rtj"PIF:IR.SEINER.QR y^y - wcZNBED .._ . q5 j7E4l1 i.RF?O $?r ,L'¢ '.ANll'LB6 COUNTY :ANO &T...A'tp: OF SEW74.CrE:.D'}&POSAL SY$:TA-1 , .. .. _ _ itALIFORN;I)4.OR THArT 1 AM TME'4eGAL.' B+R'O.P, 'ND 1'NTL.If[i'4T.O' ;p,l$CO:NIi.$C'1'P1:.UGOiN4 - - - RESIDE IN. THE.AB 8;iik4 R N•TfAL.'PR.. ER7'Y. ' - ° A:B'AIVDOI!L HOUSE.8:E1AlER' S:.GNAT. RE, AJ` � y � /y*,�' " . BAG'IfF'I.LI�SEPT❑1G'TANKHQ fi.li a':t V'Lf.I'SYI� 4aOiA 'M..'Yf: .CA'S.' :. n r u . • .ks ' ar; rwe. ' �XVK t �•...,!fin. -