HomeMy Public PortalAbout5536 MCCULLOCH AVE_Sewer__ R608->s
:E808.8-f58 f \ !APPLICATION FOR PERMIT
i 1
-
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL.
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Fmgineer
CA.$SATT D. GRIFFIN, Sups°t of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN -CROSS ST
DESCRIPTION LOT NO_' wT 4-z'/c, OWNER
BLOCK TRACT MAIL ,
T
ADDRESS: p .
r,. NO.OF BLDGS. /
SIZE OF LOT NOW ON LOT Cf TEL.NO.
USE OF
BUILDINGS DISTRICT NO. GROU MAP PROCESSDBY
CONTRACTOR PG .
ADDRESS CONNECTION DATA
CIFi" y , TEL,N0. STATION DEPTH
-7 COUNTY MANHOLE REFERENCE UPPER
REGISTRATION N0. LOWER
No. DESvRI TON' 0 0 h FEE — —
r l 7-
HOUSE SEWER CONNECTING TO % c -
PUBLIC SEWER @ $9.00 "- -
5EPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM , .
PITS AICD/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.70 P.L.
OVERFLOW SEEPAGE PIT, ORAINFIELD -
E7TN.,C_ESSPOOL,DRYWELL,MANHOLE 0 $2,00 ✓� /+ a
MOUSE SEWER CONNECTING TO P C.No;'
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMI',NO. .JOB NO.
CONNECT ADDITIONAL BLDG.OR $T.00 L)
WORK TO HOUSE SEWER TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT --- - - —
SEWER OR DISPOSAL SYSTEM a $1.00 _PERMIT NO.
INDUSTRIAL -- - -
WASTE APPROVAL
CHARGES
O'WNwS PERMIT 2 CIO CONNECTION CHARGE FEE
AORIZATION TOTAL FEE `" `''-L' REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR`S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. —_ -
SIGNED TMS DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT K g i I j,. BUILDING,OR WORK
SEPTIC TANK.,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION e
AND STATE:, THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL® DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM TH' LEGAL OWNER,OF THE ABOVE
DESCRIBED RESIDENTIAL ROPE / BACKFILL SEPTIC TANKS
SIGNATURE V d SEEP. PIT(S) ® CESSPOOLS E3
OF PERMITTE
�A
'`kALIDATI0N Rof3t~F2T A.WooD
@!tc . U.Ob cmat SUPERVISING MECHANICAL.RNGIINNER