HomeMy Public PortalAbout5348 MCCULLOCH AVE_Sewer__ _E:60-5 3-62
?BABC'LD APPLICATION FOR PERMIT f,T
I I -
COUNTY of LOS ANGELES SEWER--SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUMDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS g � E
WILLIAM A. JENSEN. Supt of Building —_._ ----- --- —
LOCALITY
FOR APPLICANT TO FILL IN CEASES
CROSS ST.
DESCRip ION LOT P40 _+�" '� y -fiOWNER —
_._ OWN
MAIL -
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BLOCK TRACT � Tar ADDS€55
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NO CJF BLDGS. � --%�
SITE OF -.OT i+:0,V ON LO'- ._ CITY TEL. NO.
15E (F
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S.ILD NGm � v,�-"" t7'iST�2lG�"NO. GROUT MAF PRC7.^,E5SFI7SY
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L BK PG
CONTRACTOR
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USE
' -- " ""`--- C'ONNECTIION DATA
STATIONr DEPTH a
CITYxry-y +' TEL NO.
- _
3
EG.: TRA ION NO ` ,�- r"y CO NTV MANHOLE REVERENCEUi�P�E
.- _ _ 1_
F _
NO, � CJESGRIF'T[OP. 01= WORE FEE SV vE OF c.ONt.E(.TIC:N LENGTH F7R[.M
_.
HOUSE 5 WrR CONNEcCT NO TO I --^F -. Y. CL HB p;t PU _ / ' - }'r WL
TO R`.L.
SLICSEW R @ $-A0 0 P C NO
SEPTIC TANK SEEPAc E P,T. OR
CJ'
PITS AND/OR ORAINtIELD sla.DO I I CO.IMP.NO, � ._ -SOB NO.
_ i_----
HOUSE CONNECTING TO B:
�'rYIVA TEDD4TRUNK PERMIT NO. ROAD PERMIT NO. 0
L SP SPOSAL SYSTEM @ $3 UQ I o.J
CONNECT 1C3D1TIONAL BLDG R i I A.FFipAV171 wglV€a E.4.'k WENT j RECORD INS TR NO. I DAVE
WORK
WORK TO HOUSE,SEWER @ 53.00
I OdF�RFLOW SEEPA E PiT DRA1NFiELD � -_L_ -..��. , C"
EAT4d,CESSPOOL,DRYWELL,MANHOLE $.5.00 ± __ _ _
-- H4 Y` OR ST.WIDENING
ALTER.REPAIR OR ABANDON HOL..:E d
EWER OR DISPO $
SAL SYSTEM RSL --E ENCROACHMENT
C.zM—ACH
: DD SrAT
- - -a -- -- -- _-_ — - z._ ENT
.PERMIT NO
INDiiS'TRIAt
WASTE APPROVAL
._..—__--.__ .__...__-_-__--___ ____-.____.L.—__._ _. _ CHARGES
OVYWER Is
00
AUTHORIZATION TOTAL FEE CONNECTION HARGEF E
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEF.;
TRACTOR TO CONNECT THE ABOVE. DESCRIBED EXISTING DWELLING
;y ___--
Td THE '. I_ SEWER. APPROVALS
DATE INSPECTORS SIGNATURE
SIGNED THIS. ._�DAY OR___�–__-_
OWNER 0;4 NEW 11003E SEWER
OWNERS AGE_IVT � —_- CONNECT ADDITIONAL I
BJILDI NG OR WORK --
-`— - '— -- — --1 — SFPTfC TANK,SEEP
I. HERt OY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND;OR DRAINFIEL
C
ANFAT' THAT THE ABOYF IS CORRECT AND AGREE TO COMPLY I4
WITH AL_L. COUNTY OROiNANCES AND STATE LAWS REGULATING
PLUMBING AND SEW F.RS. CESSPOOL L DRYWELL
_—.—_---
I HEREBY [>=Y THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LI.CENSF D AS RLQ U IREP BY LOS ANGLE'S COUNTY AND STATE OF SEWAGE DISPOSAL SYST ERd
CALIFORNIA. OR THAT I AM THE LEGAL, OWNER OF, AND INTEND T-O '- '— --'-- - ��--'--`—"'---`—"
RESIDE IN, THE A.BO��E 'ES. C
GRI PED RESIDENTIAL PROPS TY. DISCONNECT PLUG AND
,y ABANDON HOUSE EWER
S!-... UTR
t - BAC K;=1Ls.SEfT'IC TANKS
OF PERMITTEE- SEEP,PTT(J) C] CESSPOOLS LJI
VALIDATION ROBERT A. WOOD
C.K. M.O
SUPERVISING MECHANICAL ENGINEER
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a.CASH'
al+ E.