HomeMy Public PortalAbout5542-5544-5546 MCCULLOCH AVE_Sewer__ 3-64
76A642D APPLICATION FOR PERMIT _ -
6A64 -� -
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION 111111-131 NG
Y D
JOHN A. LAMBIE. Count Engineer ADRESS
WILLIAM A. JENSEN, Sup of Building
LOCALITY
NEAREST
`
FOR APPLICANT TO FILL IN ROS ST.
LEGAL li�Bob Miller
DESCRIPTION LOT NO (.'�\i_I�^� OWNER
---- `1` A.J --- MAIL__"- 15130 Ventura Ca. Sui e 320
BLOCK TRACT ADDRES�tSy, ((�q v �'T� f� (�
SIZE OF LOT -- --- NOWOONBLOTLD G S. CITY Shern3DCI lJG7- -:7 L. NO. S.1- 3-6 3uo
USE OF -°�� Cis IN-
BUILDINGS Q�I - DISTRICT NO, GROUP MAP PROCESSED BY
CONTRACTOR Green Bro Ehe s . .Lnc ♦ '.a.
ADDRESS 543 Yf• Woodbury Rd, CONNECTION DATA ..,._-
CITY .H i s d ani` $ TEL. NO. . J � R" STATION - DEPTH
HTATE
SMANHOLE REFERENCE
REGISTRATION NO. COU_NT_Y
NO. GESCRIPTiON OF WORK FEE �- �� ------- -
TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO --^ Y. CURB �� RL._"-` M.L.TO P.L. '
PUBLIC SEWER @ $5.00 _^ ---' '----- --------
SEPTIC TANK,SEEPAGE PIT OR ----itt---�� -� ! JOB NO. q'
PITS AND/OR DRAINFIELD @ CO.IMP.NO _ ____` 0
$10.00_ � ,__ V
Ii OUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. V
PRIVATE DISPOSAL SYSTEM @ $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAYIT wArvEq EASEMENT RECORD INS TR.NO. DATE
.�WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD I�._
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 _ W
j
ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING Q„
SEWER 4`P DIS^O=AL SYSTEM _@ $3.00 STATE ENCROACHMENT J,'-
PERMIT NO. _ t..--1--•—r:r- '—s —_
-- - -- - -- INDUSTRIAL �'
WASTE APPROYAL
CHARGES
OWNER'S PERMIT —��s z oo - -- —
AUTHORIZATION TOTAL FEE1 T CONNECTION CHARGE FEE - --' -- - —
'I HAVEAT THIS DATE A CONTRACT W"I TH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC 2&f ER. ft �.y�i APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS G jj,, DAY OF A 1 _t9� -- -------" --- --
OWNER OR NEW HOUSE SEWER j
OWNERS AGENT
• �i OOi.�1.lu1 b� CONN N ADDITIONAL
ADDRESS �I 'l 1? �J_"""'• 1 • BUILDING OR WORK
`- --- --- SEPTIC TANK,SEEP,PITS) i
1 HERESiY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY - .#---------I--- ----
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL f}-
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR -(
LICENSED AS R UIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM j -
CALIFORNIA OR AT I .AM THE t.EGAL NER OF, ANJIN ND TO - -
SCONNECT PLUG AND
RESIDE IN, THE BOVE DESCRIBED REST NTIA PROABANDON HOUSE SEWER
SIGNATURE SAC KFILL SEPTIC TANKS ❑
OF PERMITTEE -_ - ---- SEEP,PIT(S) 0 CESSPOOLS ❑i
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL. ENGINEER
CK. .EM.O. 6�CASH �S (. r,�+ �I [� �^,
L.I41.i0 `e_ 4 8 j�.6 Ai 1.I 2 2 1 0 D ' k 0- v