HomeMy Public PortalAbout5350 MCCULLOCH AVE_Sewer__ 7 ° D
&E-8663 91-55 APPLICATION FOR PERMIT 1
'a&E
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING tc r CC I.
ADDRESS , r'., 'S I+. ,t.C'. C I t :''ZL ` C
JOHN A. LAMBIE, COUNTY ENGINEER
CASSATT D. GRIFFIN, SUPT OF BUILDING -LOCALITY
FOR APPLICANT TO FILL IN cBOBs sr. x'r ✓Or
LEGAL --- -- — �_-_
DES CRI PT101ti 1.OT_N0. —}-` 011(-NE`R �r¢; 1-:• y 5=3 0�}" -t't
MAIL
BLOCK FRACT l r `•_7 -�.,r ADDRESS L Yyj r
N0. OF BLDGS:
SIZEOF LOT C l 1� :NOW ON LOT 9 CITY T' :.-h.t�-1 � t�` �r TEL. N0.
—. -. Ltt -
USE OF
BUILDINGS. ress3 DISTRICT NO, GROUP MAP
I BK PG
[CONNECT
ACTOR 'Tl �'
e a
ss � �5 31e 1 — __–CONNECTION DATA - --
CIT Jif ice ",(? TEL. NO. y 1 -2020 STATION --- ------ DEPTH _
-- - -- - -MANHOLE REFERENCE _UPPER
STATE LOWER
TRATION NO. -.�y+, ..a°.._'d - COUNTY --_--
DESCRIPTION OF WORK FEE '� =_ a--------
- --------- ----- -----__----.-_ --- TYPE OF CONNECTION LENGTH FRO-
HOUSE SEWER CONNECTING.TO I Y. CUPR, P,I._ M
PUBLIC5 WER @ $3.50( - ----- {.-YO P.L.SEPTIC TANK SEEPAGE P.T OR
PITS AND/OR DRAINFIELD RS 3.GOVERFLOW SEEPAGE PIDRA NFIELD P • NO.
EXTN.,CESSPOOL,DRY+.E LL,h1ANHOLE �' $2.00 CO. IMPN0. --JOB NO.HOUSE SEWER CONNECTING TOPRIVATE DISPOSAL SYSTEM ifs, S 1.00 !. TRUNK PERMIT NO. :fROAD PERMIT NO.
ADDITIONAL BLDG JR j STATE E.NCROACHRENT
_i WORK TO HOUSE SEWER CII $1.00 - 0 _ PERMIT NO -
ALTER,REPAIR OR ABANDON HOUSE --
INDUSTRIAL_-- -- - ---- - - - ---
! SEWER ORDISPOSAL SYSTEM
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT
-- +—- 0—
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE J ,
1 HAVE AT THIS DATE A CONTRACT WITHH APPROVALS DATE INSPECTOR SSIGNATURE
THC_ HEREIN NAMED CON-
TRACTOR "10 CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEINER. NEW HOUSE SEWER
SIGNED THIS--.___DAY -
OF __ _i5 CONNECT ADDITIONAL `
OWNER OR BUILD NG OR WORK
SEEP
OWNERS AGENT - - P . - _. __ .--.—�-
TIC TANK,SEEP,PIT(aD --- ------ ---__ADDRESS_ A.NDIOR DRAINFIELD
I HEREBY ACKNO-iLF..DCE THAT I HAVE READ THIS. APPLICATION - I
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL(_j DRYW ELL I I
''ITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWER OR
PLI:[ABING AND SEWERS. SEWAGE DISPOSAL SYSTEM
3 HERESY CU! THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND 1.
LICENSED A REGPEGU'RED BY LOS ANGELES COUNTY AND STATE TE OF ABANDON HOUSE SE'Ni:R
CALIFORNIA OR THAT 1 A14 'THE LEGAL OWNER OF THE ABOVE ---- -- --- --- --------- ----..--__
DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS[, f
,,
SIGNATURE SEEP. Pir(s) 0 CE.SSPOOISI
___- — -- --- ___--- -- Y- -- ----__
OF PERMITTEE - f
JOHN A.LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A.WOOD. CHIEF PLBG. INSPECTOR
CASH -
$mak F-/�--''r✓-.'.G��-e,-,=.;
76A6420
CE806 11-57 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
IOHN A. LAME, County Engineer ADDRESS
CASSATT D. GRIFFIN, Sup t of Building
LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT MAIL
ADDRESS
NO. OF BCDGS.
SIZE OFLOT NOW ON LOT
CITY TEL.NO.
USE OF
_BUILDINGS DISTRICT NO. GROUP MAP
CONTRACTOR BK PG
ADDRESS CONNECTION DATA
CITY TEL.NO... STATION DEPTH
STATE MANHOLE REFERENCE
REGISTRATIONNO. COUNTY '.; tOW€;R
N0. 1 DESCRIPTION OF WORK
110USE SEWER CONNECTING TO
__�UBLI� EWER
TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR
__�LTS O�DR�INFJELD $3__LO
±14OL CURB P.L. M�L.TO P.L.
--
OVERFLOWSEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL.MANkiOi.E @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO,IMP.NO, JOB NO.
CONNECT ADDITIONAL BLDG.OR
1_WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.,
ALTER REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIA!
_.WASTE APPROVAL
CHARCES
OWNERS. PERMIT 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON•
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS. DAY OF NEW HOUSE
T
T
I
S
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
R
0
W
U
AND/0R DRAINFIELD
A
G
N
ADDRESS -
HAVE T
C
SIGNED
OWNERT
H
H
E
14
R
E
E,
0
E
W
DR
0
A
P
A
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE, IS CORRECT AND AGREE TO COMPLY CESSPOOL[I DRYWELL El
I
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I,'HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND'/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY 1.05 ANGELES COUNTY AND STATE OF
CALIFORNIACABANDON HOUSE SEWER
ALOR THAT I AM THE LEGAL OWNER OF THE ABOVE
I
DE'C I
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS [I
T F-1 CESSPOOLS El
SIGNATURE SEEP. PIT(S)
SIGNATURE
PF
R,ITTEE__
VALIDATION--, ROBERT A. WOOD
CK. M.0. CASH SUPERVISING MECHANICAL ENGINEER
L
2633
_0