HomeMy Public PortalAbout5608 MCCULLOCH AVE_Sewer__ �r
CA642C52
eE808 3
. APPLICATION FOR PERIT
COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FADDRESS
LDING
JOHN A. LAMBIE, County Engineer
WILLIAM A. JENSEN, Supt o$ BuildingA.LITYREST
FOR APPLICANT TO FILL IN . ss 5T.
-ELEGA --- -- .-2 - -- — - - -Y -- --- --
_
f ?
DESCRIPTION .%`".G f �� „� � _ OWNER
!AAlt.
n c
BLOCK TRACT _..- �.Q ADDRESS - -
NO. OF HL
^+
SIZE OF LOTfl10W ON LO'T' CIT`/ ,.:.1-.'.. ": TEL.. NO. - .. .
USE OF DISTRICT NtJ. G'ROi7PMA? PROCESSED BY
BUIC.OINGS f -
__._. BK PCs . �
CONTRACTOR
ADDRESS CONN CTION DATA t
P
CIT'Y .. a TEL.. NO. S ATI.1 1/, 6E''fiTH •'
y fi)
J57� � -. - _
. �',C� ti. STATE MANNOL.E REFERENCE ,,�, ' y ,�:% LIPPE.R
REGISTRATION NO
..-. E,.J COUNTY ,<. - ..fL+a'. LOWER
NO.
-DESCRIPTION OF WORK FEE 'TYPE OF CONNEF. "/ -- LENGTH FROM -
—,_h OUeE SEWER CON NECT[NG 70 ,y,r.f _y, V-__ ,�.. M.L O P.L.
rT -_-
PUBLIC SEWER @ 35,00 ., �. - �. p C.NO.
E?I IC T NK SEEPAGF PIT OR r f - JOB NO
$10.00
# i PITS AND/OR DRAINF IELD @ NO. -
__v0.IMP_
HOtSSF SEW'RCONNEC71NG.70
i PRIVATE DISPOSAL SYSTEM 53:00 TRUNK PERMIT NO. ROAD PERM IT N4>--
! r ._-WlHT { E-C_ R-C fNSTR NO. DAT.ECONFC"ADDITIONA6LDG OR n ¢ . T.
.__.}WORK TOHOUSE.3FWER @ 53 OC1
_-
OVERFLOW SE EPA�GE PIT,DRALNFIELD _
EXTt ,REFAI UL,DR AN LL.DON ANHOLE lEC HWy,OR ST WIDENING
,
ALT E R.43e?AIR iJR ABANDON HbU5E �,
SEVER
OR DISPOSALY5TEM 3:3.D0 T -
_...___--__ SATE ENCROACHMENT
PERMIT NO
----" -------- -_ ._�.--------*'- '--'�-------- IND STR 4L
!, WA'rE APPR
N
' ARGEB
�V
OWR'S PERMIT s z' oo — - --— —
'�} gp �,g�ry y�ry� 7�7 ------ --- -'-- ----- - ------- - --
AV 1HO.CLIZA 1.IO1`I TOTAL FEE �
CONNECTION CHARGE F'EE.
I HAVF_' AT 7'1-11S DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMiBURSEMENT FEE _
TRACTORTO C"O:NNEC' THE ABOVE DESCRIBED EXISTING DWELLING - 'p-- -- —'----
TO THE PUBLIC SEWER. - APPROVALS DATE- INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF-----19— ---- --i` —. --� -----
OWNER OR NEW HOUSF,SEWER l.•:
i
OWNERS AGENT__-.- CONNECT ADDITIONAL
BUILDING)OR WORK
ADORE
SErtIC TANK SE P. PIT(S.)
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION ANDjr'OR DRANFILL.D
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
W: H ALL COUNT ORDINA N^.ES AND uTA�'E L.+'-<W5 REGULATINGPLU MSING AND SEWERS. CESSPOOL t.] DRYWELL u j
i
I HERESY CERTIFY THAT i AM PROPERLY REGISTERED ANC/OR ALTER,REPAIR,SEWER OR
LICE N5ED AS. REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
iFORNiA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO - - —AN—D -----
RI
ESIDE 7N, TFi'c ABgV D/E544RIHEC RESIDENTIAL Y'ROP.J2'K. DI5CONNEC7 FL trG
SIGNATURE I ABAN DON
HO.-___ 5£WER
USF
f
OF PERMITTEE. +'} �` `-' -BACKFILLSEPTIC TANKS 1�
SETT',Pi,iSt CESSPOOLS [
VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH