HomeMy Public PortalAbout5538 MCCULLOCH AVE_Sewer__ APPL6C/A'Ti0N FOR PERMIT l
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ON OF BUILDING AND SAFETY SEWER—SEWAGE D I SPOSA L
Depm'tment of County Engineer
County of Los Angeles B U I LD1 N G �y a
ADDRESS a` rlCOUNTY
WM.J. FOX,COUNTY ENGINEER
CASSATT D.GRIFFIN, SUPT OF 13UILDIM12 LOCALITY J ,
FOR APPLICANT TO FILL.M NEAREST
CROSS S
LEGAL -
Z�
DESCRIPTION LOT N0. OWNER
Xd y
BLOCK. TRACT MAIL a
- -•-5---4-p A.DDRESb
NO, O:.{. BLDGS.` "F"`✓
SIZC:OF LOT _ _ ., NOW ON LOT Ci—Y,a TEL. NO.
4s
USE OF
BUILDINGS • ' "- - DISTRICT NO, - GRO:v_P ± MAP
-- — _ - _- - -- BK PG
CONTRACTOR ---- ( j
ADDRESS CONNECTION DATA _.
GiTY ; �" TEL. NO. STATION '�" DEPTH.<
_, C1 STATE iMANHOLF REFERENCE - UPPER
REGISTRATION NO. G COUNTY ___. ._--�,. ,. J __ "_—LOWE.R
N0. DESCRIPTION OF WORK FEE- —----- -- — -- _ _. _
HOUSE
v TYPE OF CONI�7CTIOI L�•N-T P iROM
SEWER CONNECTING TO -_.
PUBLIC SEWER @ _$ 3, '`• CUFu --• P L. 'c) P L.
HOUSE SEWER CONNECTING TO
�� Pr2.1VA_TE DLS c,SAL
SYSTEM _ 1.00�__ _ _ ----------- - _.—
CONNECT ADDITIONAL BLDG.OR ><z C NO,
WORK TO HOUSE SEWER 1.00 CO. IMP, NO, O0 NO.. -�
ALTER OR P.EPp IR f=XISTING� 1 1 TRUNK PERMUT NO. — ROAD PEn'�:iT NO,
SEWER OR DISPOSAL SYSTEM 9.CO.I
6ISCONNECT AND ABANDON SEWER -_— —,.---_—_---_ _--, -
_ AhD/OR DISPOSAL SYSTEM__ 7,00 STATE FNCROA�HF.iE�:T
J�SEPiIC TfiNK.SEEPArE PIT OR PERMIT NO_
PITS AND/OR DRAINFILLD CO INDUSTRIAL
--- —_ _ WASTE APPROVAL =:
CESSPOOL DRYSVELL ., -- ---
SPECIAL CONDITIONS ONLY CHARGES
—� -- --- CC"VECTION CHARGE FEE
OV{1NER'S PERMIT --
_ $I 1� 00
AUTHORIZATION I TOTAL FEE # ���"�� EINBURSEMENT FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR
ON- T3t� T
TRAC OR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE _ INSPECTOR�SSIGNATURr.
TO THF PUBLIC SEWER --------- ----- ----
SIGNED THIa D NEW HOUSE SEWER
aF 19,
OWNER OR �" CONNECT ADDITIONAL_--
'>� r 4 BUILDING OR WORK
OWNERS AGENT ..... ::�
SEPTIC TANK,SEEP,PIT(S)
ADDRESS._ _ -� AND/OR DR.A1NfIF,t.D
IHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL{] DRYWELL0I
AND STATE THAT THE ABOVE 15 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAMS REGULATING ALTER REPAIR,SEWER 0?.
PLUMBING AND SEWERS. SEWAGE DP IR,S SYSTEM
—
LICENSED
HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR' - — -'--
LICENSED .AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS C t�
¢N ` SEEP, FIT(S) [] CESSPOOLS 0 I
SIGNATURI± � K..,. ✓g ��--..._,..__
OF PERMIT -
WILLIAM J.FOX,COUNTY ENGINEER ALWATION R.A.WOOD, CHIEF PLSG. INSPECTOR