HomeMy Public PortalAbout5514 MCCULLOCH AVE_Sewer__ i
'6AL"Zz APPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
CASSATT A.GRIFFIN, SUPT of BUILDING LOCALITY -
FOR APPLICANT TO FILLIN NEAREST
CROSS ST.
LEGAL ..� - -- --
DESCRIPTION LOT NO ";2'b ----' -OWNER
t�°-. �� -
BLOCK TRACT •-` MAIL
N0. OF BLDGS.
__SUE ^
SEOF LOT NOW ON LOT CITY TEL, NO,
USE OF
_BUtLD1NGS _ ,;r... _ DISTRICT NO. { GROUP i MAP
SK PG
CCN FRA.CTOR ( -
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ADDRESS ?Y SANTA Al'�IITA AYF CONNECTION DATA
-
CITY STATION STATION ,!`ryr ,G- Y.=J DEPTH
STATE MANHOLE REFERENCE `
UPPER,
REGISTRATION NO. ( COUNTY ..
xo�4- DESCRIPTION OF WORK FEE
HOLSE EWcR CONNFCTING TO TYPE OF CONNECTION ,I.cL. TN FROM
_�-PUBLIC SEWER _ _ ! ---. Y. _._.-. CURB` P_L� M.L. TO
C� .S 3.50 f - - .
HOUSE SEWER CONNECTING TO - i- --
_! PRIVATE DISPOSAL SYSTEM _ 1.0_0 I i- -
CC'4NFrI ADDITIONAL BLDG. OR -{ ,f �- ...t. P. C. NO.
WORK TO ROUSE SEWER- LOD� I( E._, ; CO. IMP. NO. �z "_3 JOB E tS NO.
ER OR REPAIR
SE !'< STE TRUNK PERMIT NO. ROAD PERMIT NO.
SEW 6R DISPOSAL S7 TEA t.0�, �-
DS RC CAND ABANDON SEWER
*41 STATE ENCROACHMENT
�� �/Ori fi POS:+L SiSiEi«x 3 G6 1 PERhIT NO.
1 SEPTIC TAR SECPICE PIT OR _ -- -_ -_
PITS AILD OR URSINE ELD 200 INDUSTRIAL
-- _-- -
DRY�tJtLL WASTE APPROVAL
Cc.aSPOOL - -.-•
SPECIAL CONDITIONS ONLY 2 OQ CHARGES
�F'EIIYvi11 5 t
CONNFCTPON CHARGE FEE -J
OWNEWS -� v � CO
-- ----- -- -
AUTHOI�.�ZAT,Q I TOTAL FEF. REIMBURSEMENT FEF -
cp..v
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- 7p .mss
TR.AC OR TO CONNECT THE ABOVE DESCRIBED EXISTING UkcLLING APPROVALS DAFE I NSPECTOR'S SIGNATURE
TO THE PUBLIC SEVER
NEW HOUSE S.FIWER 1
SIGNED THIS---DAY OF i°_--
OWNER OR -
CONNECT ADDITIONAL
OWNERS
_ .��. - �� BUILDING CK WORK
RS AGEN7-�, - --_ �.- �---�_—_`•
SEPTIC TANK,SEEP, PIT(S) ttt
k DDr'ES5- -i, —_^--_---`.-- _ AND/OR DRAINFIELD
} HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -CESSPOOL Q`DRY�WELL C -�
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER, REPAIR. ER OR
SEWAGE DISPOSAL ER OR
SEW
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR -- --'-'- {
EM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCOUNECT PLUG AND
CALIFORNIA OR THAT t AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SnV,IER _ 4_
DESCRIBED RESIDENTIAL, PROPERTY. - BACKFILL SEPTIC TANKS[�
SIGNATURE
SEEP.PITS ❑ CESSPOOLS 0
...
OF PERMITTEE 1}
WILLIAM J.FOX,COUNTY ENGINEER 'V'ALIDATION R.A.WOOD,CHIEF PLBG. INSPEC