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HomeMy Public PortalAbout5342 MCCULLOCH AVE_Sewer__ r , r 1 7EA6420 APPLICATION FOR PERMIT ''� COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION BUILDING � �-moi r Y VEs } JOHN A. TAMBIE, County Engineer AODs * WILLIAM A. IENSFN, Supt of Building LOCALITY FOR APPLICANT TO FILL 1N p1•S-R PT ION LOT NO `-_J LF ._.*,I` C. ' C WNF_R r� AAILa �.j i BLOCK TRACT ADDRESS 'e, y l 9 / - ° NO. OF HLDGS. - SIZE DF LOT NOW ON LOT CITY t TEL. NO. USE OP BUILDINGS DISTRICT NO- GROUP MAP PROCESSED BY BK Pc CONTRACTOR ADDREss ".�. - .tom CONNECTION DATA A _ NO/ Ai`+pry 10DEPTH /£P _L �a� CITY --� Tc .P - STATE MANHOLE RE FE RENO REGI N© DESCRIPTION OF WORK EE 7Y EGF C¢N NF�� 4N LENGTH FRO - -+ 1 COUNT HOUSE 5EW EF C.ON�NECTIN.G TO � Y � r^�1 �_P L M 7_ O P L_-� PUBLIC SEWER C3 $ .QO "- yga SEPTIC TANK _ErAGE PFT OR - - - _ - ---__- _ y,i Y C.NO. 4 P(TS P.ND�JR DRkINFIELb $10.00 co.IMP. NO. J JDB ND. U }'7U E 5 WER CONNECTING TO TRUNK PERMIT NO: ROAD PERMIT ND. U /' ' PRIIlATE D PO5A1 SYSTEM $3.007 r )F - > CONNECT ADD IONAL BLDG OR - - AFFIDAVIT I wA.!V€R i EASEMENT? RECORD.INSTR.NO. i DATE WORK TO HOUSE SEWER @ $8,00 - I,- OVERFLOW SEEPAGE PIT.,GRAINFIELD EtTJ,CE PO) RNeU $5.00 ATKHREPAIR OR A13ANROv HOUSE' - - HWY.OR ST.WIDENING SEWER.OR DISPOSAL SYSTEM @ $3,00 _.__.__ ____-__.. __..__- ._________—_-____..___-_______--..__ z _.� _. STATE.ENCROACHMENT i PERMIT NO. INDUSTRIAL TE AI'P ROVAL __.__ ___.__. __.._ w __— { yr _ xR OWNER" Pi 2' oo - - --- --- --- -- �.' ..�._ CONNECTION CHARGE FEE E£ AUTHORIZATION TOTAL F -- --- - --------------------- ------ I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N✓CMED CON- HEIMBU RSF_MENT FEE TRACTOR TO CONNECT THE. ABOVE. DESCRIBED EXiSTING DWELLINGpy. TO THE PUBL:C SEWER. - - - APPROVALS DATE TINSPECTOR'$SIGNATURE _.__-.___ __.___.-_-___...__.__. _-__Y.- _ __---_-_ -_.__-_�.__-_. SIGNED 7'Hi5_. _ ._..l3AY OP :_—_--------13__. _ --- OWIWFR OR .r._ NEW HOUSE SEWER I OWNERS CONNECT ADOfTiONAL WORK ADORE,s'r__.-_ BLILD{NC OR WORK -SEPTIC TANK,SEEP.PIT(.S} 1 HER55Y ACKNOWLEDGE THAT HAVE READ THIS APPLICATION AND.'OR DRAINF7ELD � AND STATE THAT THE A8OVE iS CORREC"T AND AGREE TO (COMPLY - WITHALL. COUNTY ORDINANCES .AND STATE LAWS R'EGUL.ATING � PLU MC+INt AND SEWERS. [-ESSPOO[ �..; ORWEL.L. H LREBI CERTIFY THAT I AM P90PEPLY REGISTERED AND,!OR. ALTER,REPAIR,-SE'V'ER CR I_!CENED AS REQUIRED BY LOS ANGLES COUNTY AND STATE Or SEWAGE DISPOSAL SYSTEM ! CALI.I_ RN IA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO - DISCONNECf PLUG AND - �---�-- -_ RE5IDE IN.. THE AB;:.:yE +DESGEEiBr.,.D RESiDF.Rv71AL PHOPE RT'Y. _ N - _— <D ABANDON HOUSE SEWER SIGNATURE: y � �+,�„s, BACKFILL SEPTIC TANKS �OF PERM'TT'EE__ _ _ SEEP.PIT(S3 Ij CESSPOOLS (�I VALIDATION. -- ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK, M.O CASH a ��Eaae 76A542D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, Gundy Engineer ADDRESS c, WILLIAM A. JENSEN, Supt of Building -'-- LOCALITY NE FOR APPLICANT TO FUL IN CROSS ST. BU'L'7­�, A DDREss �A.r N DESCRIPTION LOT NOOWNER MAIL BLOCK TRACI OF B L DG'S. SIZE OF LOT Novi ON LCATNO. 7 LEE OF BUILDINGS DISTRICT 140 MAP FROCESSED By BK PG CONTRACTOR J ADDRESS _CONNECTION DATA CITY I EL. NO. -TiT, N DEPTH STATE MANHOLE REFERENCE REGTTRATION NO. COUNTY OF WORK NO )(PE OF LENGTF _EON- M.L.TO P.L HOUSE SEWER NN ECTII NO QN PUBLIC SEWER @ SS-00 'f - — -- -- --- -- I l-, �� P.C..NO. s E�T�I6 TANK N��,s, Co.IMP. NO JOB NO. PITS AN0/QR ORAINFIELD @ 31000 HOUSE SEWER CONNECTING TO T TRUNK PERMIT NO, ROAD PERMIT NO. PRIVATE OfSPOSAL SYSTEM @ sq.00 0 CONNIF(,-T ADDt-$ONAL BLDG.OR AFFIDAVIT ' WAIVER EASEMENT RECORD. No. DATC ",WORK.TO HOUSE SEWER @ VERPOW L OSEEPA<i---PIT,DRAINFIELD E _j HWY,OR ST WfDIE'NiNG AL ER.REr�;WIROAASXNDON HobSE 'EWEH OR DISPOSAL.SYSTEM $3.00 STATE ENCROACHMENT PERVil NO, INOUSIF?fAL WASTE APPROYAL OWNER'S P ERMIT AUTHORIZATION TOTAL FEE #77 HAVE DWELLINGAT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- RE[-M B U HSE M N T r EE: TRACTOR TO CCNNECT THE ABOVE DESCRIBED FXiSTINDWELLING'0 T!E F00 I-I:'- SEWER, APPROVALS DATE j iNSPIECTOR'S SIGNATURE SIGNEDTHIS.—_DAY 05 0 W N E P )R NEW HOUSE SEWER OWNERS CONNECT ADDITiONAL BUILDING OR WORK SEPT_,T! TANK, PIT(S) I HEREBY ACKNOWLE-:,"GE: THP.. I HAVE READ TV41S APPLICATION ANO/QR nRAINFiELD AND0 3 E` TATTHAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY W H ;T ALL, COUNTY ORDINANCES AND STATE LAWS REGULATING 0 PL.U MB INN AND _EWERS. CESSPOOL Ej DRY-ELL IHLREBY CERTIFY THAT I AM PROPERLY RFIIST-F.RED AND/OR ALTER,REPAIR,SEWFR OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM C ALFORN'A OR I HAT AM,THE LEGAL OYINER OF, AND INTEND TO Dj,5CONNFCT_JPLUG A D � 'T RESIDE ES D E I N, THE A SiR'7RES!DENTIAL Pr SIGNATURE: ABANDON HOUSE SEWER KS OF PERMIT) BACKFILL SEPTIC TAN —A SEEP.PIT IS) E.:SSPOOLS [j VALIDATION-,_SHROBERT A. WOOD CK. M, 0. �fA I SUPERVISING MECHANICAL ENGINEER _ J" A,