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HomeMy Public PortalAbout5344 MCCULLOCH AVE_Sewer__ Lct'DEi.?-Ci2 76A�b`4`LD APPLICATION FOR PERMIt COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL Of COUNTY ENGINEER BUILDING FIND SAFETY DI`J'ISION FNEARKST JOHN A, LAMBIE: County Engineer WILLIAM A. JENSEN. Supt of BuildingYFOR APPLICANT TO FILL IN STS s ---- -- DESCRIPTION LOT NO ; 0'NER J" TRACT ADORES ,� S1 Z 1 t BLOCK FSA IL BLO NOW N LOT._. _ -- ('i"TY OFO 'BLOTS. A, d - E OF LOT USE OF suILDING$ DIST'RIC'T NO.. GRO4IPj MAP PROCESSED BY d � - s ADDRESS + _ - y y.:.re. r. CONNECTION 8 .. DATA DEFT a . }? __ CITY TELNO. _ _ f COUNTSTATE Y MANHOLE REFEE 9 f I 13(+(-�E2 REGISTRATION NC 'w d:: .— - NO. TIESCFd PTI N OF ORK FEE TYPPO�'CONNE�t, I.ON LENGTH FRO1$' f'" Y f ./ yy .x M.L.TO P.L. PUBLIC SEWER $5.00 P G.NO. 0 -_-rtEPS Ie.7ANK '' l CO.IM NO: / i JOB NO, PTS AND/OR DRAINEIELD 310.0 O� _� CO. H6UgE SEWER CONN ECY'ING TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATF.DISPO$AL SYSTEM 53.00 - ___._ ___ -___._may - _._I __ __ ___._ _— ____-71 ( TNNFC T ADD. ,ONAL BLDG OR '� Af FIDAVlT rwAirCk T EASEMF�i RE:GOfiD IN"` R.iV O. DA-TE WORK TO HOUSE SEWER $300 O✓EP"r LOW SEEPAGE PVT OR AINF.ELD i----� FXrq�-.CF SPOOL.DRY WELL MRN-Sb HOLE @ $5.00 I ' _—_- __ ___ __ WY..OR S7 WIDENING ALTER.R i OAI R ABANOON HOUSE EWER OR DISPOSAL,SYSTEM C 53.00 ! I. --____ .,_..__—.------ ____--.�__�. _...___ ATE NC R OAC M c NT - l PL 4ri9(S'NO_ INDJSTR l+L ! W ,PER I A T a QNAL � � OWN °S PERMIT' � z o© z�. + °� _ c t kGEs AUTHORIZATION I TOTAL FEE CONNECTION CHARGE FEE 1 .4A VE AT THIS DATE A CONTRAC'4' WITH THE HEREIN B4AMED CON, RE1MSUR EM"r._1T FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ------ - ---- ----c---------T --. ----------:---__�_„_-_ TO THE PUBLIC SEWER, APPROVALS DATE i INSPECTOR'S SIGNATURE: SIGNED THIS DAY OF _-- - -- ---- --� -- - -- r- OWNER C'?R -- _ T— NEW hi OI.SE SEWER — OWP<Ei75 AGENT CONNECT ADDITIONAL---- -- - ----_ BUIL.O NG OR WORK ADDRESS____,--__--_._. 5E',PTIC TANK.,SEEP,P IT{S'; t i HERr BY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION ION AND/OR DRAINFIELD AND SATE THAT THE 4604 IS CORRECT AND AGREE, TO COMPLY WkTH ALL CO 1...Y C?F'DINA LACES AND STATE LA''.i'S REGIl LA]'INT PLUMBING AND SEW eRS, CESSPOOL. ❑ DRYWELL ❑1 H R[BY CERTIFY THAT AM PROPERLY. REGISTERED AND/OR AL.TER RE PAIR,SEWER OR LI;:C dSF_D AS REOU}RED 61' LOS ANGLES c:OUNTY .AND STATE OF SEWAGE DISPOSAL.SYSTEM CAL?FORMA OR .'HAT f AM THE EGAL OWNER OF AND INTEND TO DI LONN-r PLUG AND kESiDE IN, THE ABOVE D SCR! ED RESIDENTIAL PROPERTY, AGANCON HOUSE SEWER _t SIGNATURE OFBACKFILL SEPTICTANKs El SEEP,PIT($) ❑ CESSPOOLS [] I VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL. ENGINEER CK. M.O. ,.PASH 12 1 y } 7 6A 6 4 -50 APPLICATION FOR PERMIT ,. :' COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISIONrc-Ross U!!n N1-1 JOHN A. LAMBIE, County Engineer WILLIAM A. JEiNSEN, Sup't of Building LOCALITY FOR APPLICANT TO FILL IN 57 5 GE"CRt AiL.ON LT NO 4 �. '' C.g✓$' /y^4,, -- .. .. _ WME MAIL BLOCK TRACT '{ ADDRESS NO. OF BLDGS.. yy rr.: .1... S17'F OF NOW ON LOT I. CITY "y '2-vE "', JiC:,t �I" DT b t a" 7 USE OF _BUILDINGS '{},` �,+"s - D;STRlCT NO. tiROUP `M dap t' PROCESSED By PG _ __. Aw CONTRACTOR del � .Aly �`.' i ADORES c.•- }}'� ti' f' a ,r. .i` CONNECTION DATA CITY ' x TEL. NO., r '. +y,dr. tstiy BTXT!ON ✓..A , DEPTH --'� i 1 REGI TRATION M1.O �- ,r„�f� 4 L^C- STATE MANHOLE Rf LRENCC - COUNTY 1 F NII. C7ESCRIPT N OF WORK FEE TYPE OF�C✓ONNECY�. i LENGTH FR(�? �^ HOUSE SEWER CONNECTING 70 Y Y '•'L sY` G,_ M.L TO P.L.> �.. PUBLIC SEWER @ S5.otJ - ______..-__ P.C.NO SEPTIC T NK.SEEF'A,E.PIT OR - PITS AND;OR DR.A NFIELD slox)o I CO.!MP. NO. t J06 NO HOUSE SEWER'CONNECTING 7O - PRIVATE DISPOSAL S STEM $3,qp �. TRl`NK PERMIT' NO. ROAD PE:k MIT NO. +' C0NNE1,T A676 L ONABLDG OR AF'FiDAVIT wrilVdA rASrMEnT RECD RD.INSTR No. T DATE I WORK TO HOUSE SEWER @ $3.00 f OVERFLOW SPCPAGF PIT DRA NFIF'LD A - CE.S POO L.DRt W-L. -I N--- $--— __ r-_ ,_.__.___. H:My.OR ST,WIDENING . PL7E.R,REPAIR OR ABANDON HOUSE 'EWER-PR DISPOSAL SYSTEW} �� S3.D0 __.-. ._.» STATE ENCROACHMENT . PER-IT NO. INDJ5TRfAL - - t \N4 TE APPROVAL c.._ OVVNER�a PERMIT — a CON NE ION CH ARSE FEE AUTHORIZATION TOTAL FEE -- -.___ -_ -- ----.-__--------_-----------_ -- 1 HAVE AT 'TNPS DATE A CONTRACTWITH THE HEREIN NAMED CON- REIMBURSEMENT FEF. TRACT CONNECT THE ABOVE DESCRIBED F-X15"TING DWELLING ----- - - ---- - - -- --- TO'fH= PUBLIC SEWERS -AT-APPROVALS INSPECT>R SIGNATURE 1i^E0 THIS----DAY GP- .- ---1�-`-- --- -- --- - `-- - ---- -- ONNER OR y - NEW HOUSE SEWER rrr OWNERS ,a.GF:NT�- T --__ _. __.._.�... CONNECT ADDITIONAL BLIILDI NO OR WORK _._.___..._.. ADDRESS -- - ------- SEPTIC TANK,SEEP,PiT'{S) i I HFRESY ACKNOWt.E'U E THAT I HAVE READ THIS APPLICATION ANU,'OR D44+f�FFIE LD j AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING::. PLUMING AND SEWERS. CESSPOOL i-_1 DRYWELL r� I HEREBY CERTi FY "THAT I AM PROPERLY REGISTERED ANO/OR ALTER,REPAIR,SEWER OR L!CE.NSEDAS REQUIRED BY L.OS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM I CA!_I ORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO ---. -___ DISCONNECT PLUG AND Fi€5rDE IN. THE ABOVE: D 'CRIB RE5IDEN?"PAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE: Ems. BACKFILL SEPTiC TANKSOF PrkMrrT;l SEEP.FIT(5) �,� CESSPOOLS ! VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL. ENGINEER CK. M.O e %CASH /� e