The URL can be used to link to this page

Home My Public Portal About5428 MCCULLOCH AVE_Sewer__ '6A 6420 -CE808-10-71 APPLICATION FOR PERMIT i. COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING �+"' ADDRESS s� 6+-' Y - � �S•`7C ef. LOCALITY '04., It FOR APPLICANT TO FILL IN NR..SsST. LEGAL DESCRIPTION LOT NO. OWNER /E ! 1 ei cam'' MAIL BLOCK TRACT ADDRESS - - NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. 7C V USE OF _ BUILDINGS DISTRICT NO. GROUP MAP � PROCESSED BY BK PG CONTRACTOR - i� Y ,,, ��: - f I ADDRESS —� AA�_i<} .a _' y�: CONNECTION DATA _ E Y` CITY � � y TEL. NO. STATION DEPTH STATE LIC CLASS A""" MANHOLE REFERENCE ` LICENSE NO., d No. DESCRIPTION OF WORK FEE — LOWER TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO Y. CURB �. P.L. - M.L.TO P.L. PUBLIC SEWER 0 $7.00 �- SEPTIC TANK,SEEPAGE PIT OR P.C.NO. ` PITS AND/OR DRAINFIELD 0 510.00 CO.IMP.NO. JOB NO. _ HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N O. a PRIVATE DISPOSAL SYSTEM @ S3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMENT RECORD.INSTR.NO. DATE U WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL. 0 $5.00 O ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ $_3.00 _ .STATE ENCROACHMENT W MANHOLE @ $7.00 PERMIT NO. a INDUSTRIAL N WASTE APPROVAL z OWNERS PERMIT $1 31 00 CHARGES AUTHORIZATIONJ TOTAL FEE CONNECTION CHARGE FEE 1 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 _ I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S) 4 _ AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD - WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING t" _ PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ „' - 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR TH=611:7. EGAL OW NF '�AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AO Rfi„a'FIZ?EN} L ROPER;Y. ABANDON HOUSE SEWERSIGNATURE ' r r OF PERMfTTEE_ BACKFILL SEPTI -TANi(S ❑ SEEP.PIT(S) C�SSPOOLS ❑ - VALIDATION clt.`� M.o. casr;� —�— 6 6 Vr.40Y r-ll 0 1 UAtif V I®Jw 6A 642D-CE808 -10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION 7NEAREST {� s fL 5Y FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO. ;/ OWNER („� { F r, - i y MAIL BLOCK TRACT P } .J : ADDRESS ,Y'..3`- NO. OF BLOGS. y y SIZE OF LOT NOW ON LOT CITY TEL. NO. 9' USE OF DISTRICT NO.. GROUP MAP -'-PROCESSED BY BUILDINGS BK PG CONTRACTOR ' ,3 tw" .. l.✓{ y ADDRESS `` e� � a CONNECTION DATA CITY �>y" TEL. NO, STATION 1` DEPTH �PiEER STATE t}J LIC ,r.e-} MANHOLE REFERENCE LICENSE NO, ^' "`( -� CLASS (`- LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION_. LENGTH FROM HOUSE SEWER CONNECTING TO ,-7 Y. CURB _P.L� M.L.TO P.L. PUBLIC SEWER @ $7.00 - P.C.NO.CO.IMP. NO. JOB NO. SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR GRAINFIELD 0 $10.00 /! HOUSE SEWER CONNECTING TO . ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM 6 $3.00 TRUNK PERMIT NO. CL CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER -EASEMENT RECORD.INSTR,NO. DATE WORK TO HOUSE SEWER $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD - EXTN..CESSPOOL.DRYWELL, $5.00 ALTER;REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM $3.00— - STATE ENCROACHMENT W MANHOLE $7.00 PERMIT NO. Q„ __— H -- INDUSTRIAL. Z WASTE APPROVAL CHARGES OWNER`S PERMIT $ s 00 AUTHORIZATION TOTAL FEE �v; CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE [INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER _ OWNERS AGENT CONNECT ADDiT10N AL BUILDING OR WORK ADDRESS - SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -- WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIR Y LOS ANGLES COU Y AND STATE OF SEWAGE DISPOSAL SYSTEM G AL FORM OR TH I A. THE LE((:t OW N,f;E' 0 , AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOWE SCRIBED' iD 1 PROPERTY. ABANDON HOUSE SEWER SIGNATURE `{' OF PER MTTTEE ^'xF(' -'�' BACKFILL SEPTIC TANKS ❑ SEEP.PIT(S) ❑ CESSPOOLS E] VALIDATION. `K M.o. CASH j a 7 714iiiii GiI1U