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Home My Public Portal About5426 MCCULLOCH AVE_Sewer__ '6A 642D-CEBOB-10-71 6� APPLICATION FOR PERMIT S� COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING / ADDRESS 6 /M` :' ��++�� LOCALITY :01-1(1 FOR APPLICANT TO FILL IN f...SSSST. E' -�- LE ----- -- --- DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ,.`Y --_- ---_ ADDRESS ej.� NO. OF BLDGS. ./ SIZE OF LOT NOW ON LOT CITY i TEL. NO. Lri� USE OF BUILDINGS DISTRICT NO. GROUP BK MAP Fe �$iCE SSED BY CONTRACTOR - /y 1 j ADDRESS A,� r //:-- �; ref .+ CO t ECTION DATA CITY rlATE .11} yTEL. NO. �/.,j L STATION I 4 DEPTH LICENSE NO. V°`"' / �' F-✓ Lic GLA 55 `� '"� MANHOLE REFERENCE t,., r �/ . Zj �.' LOWER l..-� j NO, DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB 12-4_. M.L.TO P.L. PUBLIC SEWER $7.00 . --'- _ P.C.NO. SEPTIC TANK,SEEPAGE PIT OR CO. IMP. NO. JOB NO. PITS AND/OR GRAINFIELD $10.00 HOUSE SEWERCONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. CL PRIVATE DISPOSAL SYSTEM @ S3.00 0 CONNECT ADDITIONAL BLDG.OR .AFFIDAVIT wAlvfR EASEMENT RECORD.INSTR.NO. DATE V WORK TO HOUSE SEWER Q 53.00 OVERFLOW SEEPAGE PIT.DRAINFIELD -___t XTN.,CESSPOOL ,DRYW ELL. @ SS.GO HWY.OR ST.WIDENING Q ALTER,REPAIR OR ABANDON HOUSE F' SEWER O_RD_ISPO_S_AL SYSTEM @ S3..0_O STATE ENCROACHMENT W MANHOLE ® $7.00 PERMIT NO. a -'— -- -- - INDUSTRIAL V) WASTE APPROVAL Z OWNERS PERMIT f 3 00 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL. FEE __- - I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT --'-' ' CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP,PIT(S) 1 HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL Ci I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES CO Y AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR TNATHE LEGAL OW OF AND INTEND TO DISCONNECT PLUG AND RESIDE IN. THE AZE;t)�E�.:C�RIIBED R I ENT AL ROP TY. ABANDON HOUSE SEWER SIGNATVRE > `: r° �/ BACKFILL SEPTIC TANKSOF PERMITTEE ❑ '- ---- SEEP.PTI., ❑ CE ?OLS VALIDATION CK M.0. ;CASH . li- uv 11 1 v 0 1 J. ♦ r1 6A 642D-CE806-10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING �/ ��e ADDRESS ', ,,;', - e 4.. &4 LOCALITY �- FOR APPLICANT TO FILL IN CROSSSST. LEGAL DESCRIPTION LOT NO. OWNER (,..- �v`k MAIL BLOCK TRACT - ADDRESSrf` NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. G✓ S^ USE OF BUILDINGS DISTRICT NO. GROUP MAP PEOCESSED BY BK PS CONTRACTOR Ile ADDRESS�° � _ `'g -.G . ' CONNECTION DATA 11 ' STATION DEPTH CITY 4J TEL. NO. ` c( �y _ -UPP2R- STATE { LIC 2 MANHOLE REFERENCE J LOWER LICENSE NO.� 6- J CLASS L .. _ NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION _ - - LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB ` _P.1-. M.L.TO P.L. PUBLIC SEWER 0 $7.00 SEPTIC TANK.SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD $10.00 CO. IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO, 0. PRIVATE DISPOSAL SYSTEM Q $3.00 0 ~_ CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EA5f M[NT I RECORD. INSTR.NO, DATE U WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD OC EXT N.,CESSPOOL.DRYWELL. @ moo HWY-OR ST.WIDENING 0 ALTER,REPAIR OR ABANDON HOUSE H' SEWER OR DISPOSAL SYSTEM $3.00 -- W — ------- -- STATE ENCROACHMENT MANHOLE $7 QD PERMIT NO. Lb -- -- INDUSTRIAL h ��+IYL. WASTE APPROVAL CHARGES Z I OWNER'S PERIYIIT--�-�— $ 3 00� CONNECTION CHARGE FEE AUTHORIZATIONI TOTAL FEE - IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL y'id` '.Lr+• ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(S) ,J 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY WITH ALL. COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND 5EW ERS. CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THAT 1 AMPROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED A5 REQUIR Y LOS ANGLES ?[,41IA71ROPERTY. AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR TH.['T I A THE LEG`�OWAND INTEND TO DISCONNECT PLUG AND f RESIDE IN. THE ABO SCRIBED` £. IDE ABANDON HOUSE SEWER SIGNATURE g� (y,/OF PERMITTEE r'ao P � (_. BACKFILL SEPTIC TANKS ❑ - - ---"- SEEP.PIT(S) ❑ CESSPg LS VALIDATION CK. ,0. a CA5H