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Home My Public Portal About5512 MCCULLOCH AVE_Sewer__ 16A;42b - CE808 - 9/73 APPLICATION FOR. PERMIT COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FD. G S Y T ' FOR APPLICANT TO FILL IN CROss sT. LEGAL � ✓' �- — - DESCRIPTION LOT NO. ry1 .. ,1{,,- OWNER ;^ y b MAIL BLOCK TRACT r'%1 ADDRESS rOF BL -- _ 5. SIZE OF LOT NOW ON LOT CITY;;'£� + ,r: "+-� TEL. NO }' '�s USE OF ,�'`'_ BL'1LDINGS_` - _ DISTRICT HO.1 GROUP MAP PROCESSED BY BK PS CONTRACTOR - �� ADDRESS - CONNECTION bATA CITY TEL. NO. - STATION "' - DEPTH STATE LIC -- MANHOLE REFERENCE UPPER LICENSE NO, 1_ _: ,< ,'�i G1A55 LOWER No. 1 DESCRIPTION OF WORK FEE 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 60.00 CO.IMP.NO. JOB NO. HOUSE.SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT N01� j PRIVATE DISPOSAL SYSTEM $3.00 // CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVEE EASEMENT RECORD.INSTR.NO. DATE' 7„ WORK TO HOUSE SEWER ® ;3.00 p- OVERFLOW SEEPAGE PIT,DRAINFIELD o EXTN..CESSPOOL.DRYWELL. 5500 HWY.OR ST.WIDENING` y -ALTER.REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM 0 $3.00 - -----�- — — STATE ENCROACHMENT }-� MANHOLE.- $7 00 PERMIT NO. fJ�.l. =- INDUSTRIAL a- WASTE APPROVAL CHARGES OWNIrR`S PERMrr _Alm' — CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE --- — 1 HAVE AT THIS DATE A CONTRACT WITH THE.HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR T0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING �w�t -- TO THE PUBLISEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS_ _ DAY OF _ f9_ OWNER OR NEW HOUSE SEWER OWNERS AGENT _ -- -- CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR TANKS LFL PIT(S) AND/OR DRAINFIELD AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY -- -_.---. WIT HALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWE.LL ❑ HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CA LIFCR NIA OR THAT IAM THE LEGAL, OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTYAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE _ —^ OF PEOMTTTEE� BACKFILL SEPTIC TANKS ❑ BEV.PIT(5) q"POOLS ❑ VAd.DA)ION cK. M,O. CASH 1 9 1(`. �y, aC APPLICATION FOR PERMIT COUNT? OF LOS ANGELES SEWER-SEWAGE DISPOSAL lFrAR'I`IINE=,-T 01 COUNTY ENGINEER EUILDIN6 ANI_ "�4FETY DIVISION FNEA ,¢ ". - FOR APPLICANT TO FILL. IN CROSS Sr LEGAL DESCRIPTION LOT NO. OWNER 6----ice--. MAIL BLOCK TRACT + v - ADDRESS SIZE OF LOT 6N LOT CITY-,, - TEL, NO., USE Or BUILDINGS„/"- DiSTRICT IVO. �-rRO'UP SK MAP ps PROCESSED BY CONTRACTOR _. a y n 9 ADDRESS CONNECTION DATA ___ STATlO CITY _a"' ,Y': ` ;DEPTH - TEL. NO. ' _ STATE _ f T LIC ---_�.�__ -..�.. MANHOLE REFERENCE U � LICENSE NO, CLASS ,{' i - TIeCIWER_'r NO. I DESCRIPTION OF WORK FEE _ ..�, 'TYPE OF CONNECTION LENGTH FROM HOUSE SEWER CONNECTING TO yY. CURB P.L. M.L.TO P.L. 'PUBLIC SEWER 0 $7.00 / '— SEPTIC TANK,SEEPAGE FIT OR P.C.:NO. PITS AND/OR DRAINFIELD $10.00 CO,IM.P NO. --� y JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM @ $3.00 p -- CONNECT ADDITIONAL BLDG,OR AFFIDAVIT wq!v[R EASEMENT EAY RECORD.INSTR.NO.. DATE ?' WORK TO HOUSE SEWER � $3.00 � � OVERFLOW SEEPAGE PIT,DRAINFIELD - O EKTN..CESSPOOL,DRYWELL.. $5-,00 s - HWY.OR ST.WIDENING ALTER,REPAIR OR ABANDON H-OUSE yµ ` I .:3-:#. u"`'-, "^' y4 e<<;P-,.,'... SEWER OR DISPOSALSYSTEM $3:00 STATE ENCROACHMENT h- MANHOLE ._ $,.00 PERMIT NO. _�,_ Lq.i -- INDUSTRIAL 0- WASTE APPROVAL � OWNERS, PERMIT S 3 00 CONNECTION CHARGE FEE CHARGES AUTHORIZATION TOTAL FEE �.; �' I HAVE AT THIS DATE A CONTRACT WITH THE HERE!N NAMED CON• REIMBURSEMENT FET TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALSE. TO THE PUBLIC SEWER, DATE INSPECTOR'S SIGNATURE SIGNED TH1S - DAY CS... :.-..�.,: 19,�_ - — OWNER OR - NEW HOUSE SEWEROWNERS AGENT -- CONNECT ADDITIONAL BUILDING OR WORK ADDRESS �— SEPTIC TANK',SEEP.PIT(S) IHEREBY ACKNOWLEDGE THAT I 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 SEW ERS. CESSPOOL DRYWELL [� I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES .COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFGRNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE _ -------�- OF PE*.MTTTEE ' - _ BACKFILL SEPTI--IC! TANKS - SEpE�P,PIT(S) Ej"' CESSPCP VAL}rDA1TION CK. /M.0. CASH j :