HomeMy Public PortalAbout5502 MCCULLOCH AVE_Sewer__ DEE"rYiENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING A1VD SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FCX, COUNTY ENGINEER I BUILDING E
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
• BUILDING NEAREST
ADDRESS CROSS ST.
LOCALITY DISTRICT N0. SERIAL NO. PERMIT NO.
NEAREST A `,!` �%. . `!��'' • $
CROSS ST. /
RECEIVED BY Roady for InapecHicn DATE ISSUED
OWNER w
NAIL
ADDRESS USE ZONE OCCUPANCY NAP
I BK PG
CITY TEL.NO.
CONTRACTOR ,.
CO.IMP.N0.
ADDRESS
JOB NO.
CITY_ TEL.NO. TRUNK PERMIT NO.
REOISTRATaON NO. ^srATECOUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOBS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO.I DESCRIFTICN OF WORK FEE --
HOUSE SE\:EB CON&tECTI_PIG TO I REIMBURSEMENT FEE
/ PUBLIC SEWER Q $ 3.50 RECEIPT 10. i DATE 113Y
HOUSE SEVAR COpNECTING TO 1
PRIVATE D18POSAL SYSTEf. 1.00
CONFECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ACTEB 06 PJO.REPAIR EXISTING I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISC�HldECT AaD ABANDOP�SEWER !
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION
CESSPOOL•—DRYWELL _+ DEPTH
SPECIAL CONDITIONS ONLY 2.00 i MANHOLE REFERENCE
upp.CR LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS —,PERMIT $ 1 00
Y. CURB P L. M.L.TO P.L.
;
AUTHORI7-ATIONTOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING - APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWED
SIGNED THIS-,.""___.DAY OF. ___ __._...19____ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT................ __.-•__• _ BUILDINC OR WORK
EPTIC
ADDRESS....................................... -...................:_.._... - ._._..:.-.
AND/OR DRAWF ELD PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMB:NG AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AIMTHE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)1] CESSPOOLS
SIGNATURE
OF PERtlITTEE...-_- .-.:r-..__.-°_-..._..-•---
76A642D 663 1/53
DEEPAIt:TA ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FD NOOR APPLICANT TO FILL IN LOCALITY s� _
ADDNEAREST
UILRESS CROSS ST.
Yw
LOCALITY Ifs DISTRICT N0. f8ERIAL N0. PERMIT� fNO. '
NEAREST c.�> tra p� A/ �� ✓D�/`r J
GROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER G'
MAIL USE ZONE OCCUPANCY MAP
ADDRESS z<
BK PG
CITY TEL.NO. � 5
CONTRACTORj�rrff l, :^s r •, CO.IMP.NO.
ADDRESS (�����sq—`��! /� —
g�, �l�--�I--r` JOB NO.
--- -- -
CITY: TEL.NO ,f-: TRUNK PERMIT N0.
REGISTRATION N0. „`®(r i H CSTATE
OUNTY ROAD PERMIT NO.
LEGAL ,..,,f tp a..w...a.Al. -
DESCRIPTION LOT NO..« ! � STATE ENCROACHMENT
�};� PERMIT NO. - --
BLOCK TRACT IliF E INDUSTRIAL
� WASTE APPROVAL: -_---—_.---
SIZE OF LOT N0.OF 6LDGS.
/f C NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. i DESCRIPTION OF WORK FEE
HOUSE ER N
SEWCONECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
A-ME if OR REPAIR EXISTING 'ID- DE I BY
SEWER OR DISPOSAL SYSTEM 1.00 - AT
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR o
PITS AND/OR DRAINFIELD 2.00 STATION /,J 6�6 DEPTH /
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 i/ p NHOLE REFERENCE
L UPPER LOWER
—. TYPE OF CONNEC ONLENGTH FROM
OWNERS PERMIT $ t 00 -
Y- ! CURB P.L- M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS !NSPECTOR'SSIGN ATURE DATE
SIGNED THIS .-....DAY OEf.
....................19-19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT:..'-.•�.1l1'--..-.-.._-...- _ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS................................................_..-.... ... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN.
ER OF THE ABOVE DESCRY€D RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS El
SIGNATURE SEEP-PIT(S)Ej CESSPOOLS
OF PERMITTEE--•-`'- -- .`.......-•-`-.._.:_.. ................-.......
76A642D 663 1/53