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HomeMy Public PortalAbout5614 MCCULLOCH AVE_Sewer__ 'zz CEBOS 7QA(j42D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Supt of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL: DE5C:R.!PTIO,N _1.1 NO. 2 OWNER �7 MAI L,D C�� TRACT ev df L ADDRESS NO. OF B 'DC OF LOT NOW ON LOT CTryTEI­ NO. -------------- US-E- Q DISTRICT NO. 'R-UPMAP P "55D By 1 RK PG CO NTRACTOR ADDRESS C NECTION DATA CITY / TEL. NO. ATION - DEPTH ly RFGISTRArZQN NO. ❑ STATE MANHOLE RFFERENCE L] COUNTY 1 0 -DESCRIPTION OF WORK F C. N FEE TYPE LENGTH pT.ROM: HOUSE SEWER CONNECTING TO 1 >--I' y L. WL TO PUBLIC SEWER $! 0 0 --33 P C, Na EFTIC i 08 S TAINK'SFEPAGF PI' OR _CC`_IMP.N c, JOB NO PITS ANDS OR DRAINFI El 0) $;0.00 HOUSE SEWER CON VE :f: TRUNK PERMIT NO. ROAD PERMIT PRIVATE UISPOSAL SYSTEM $300 0 C Asim4NT-F RECORD.INSTR.NO. DATE CONNECT ADDJTIONAL BLOG OR AFFIDAWIT-1 Wm": w ORKTO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DrAINFIELD EXTN�,CL-'�SPOO�,,P_RYWELLMAN�iOL.E 0 $5.00 HWY.OR ST.WIDENING, ALTER.-REPFIR OR ABANDON HOLift SEWER 0 DISPOSAL SYSTEM @ STATE ENCROACHMENT PERMjT NO, WASTE APPROVAL CHARGES ovalmRIS PERMIT 2 -©-O- _ — ------ CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 4­r� ---- -- — - ­­ ---- IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON• REIMBURSEMENT FEE T CO RATR TO CON I NECT TiF ABOVE DESCRIBED EXISTING DWELLING 70 THE F,UaLIC SEWER. APPROVALS DATE I INSPECTOR'S SIGNATURE SIGNED TH1S ­—DAY OWNER OR OWNERS AGENT----_—- NEW HOUSE SFW CONNECT ADDITIONAL ADD.RF HDINOR WORK UNLG S!FrT(C TANK,SEEPT I HEREBY ACKNOWLEDHT I HAVE READ THIS APPLICATION ANI Orc PIT(S) D GE THAT IS CORRECT AND AGREE TO COMPLY DRAINFIELD A N STATE THAT THE A WITH i 1 H ALL COUNTY ORDINANCES AND ST'AT'E LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ ORYWELL HERESY CE.RTJFY THAT AM PROPERLY REGISTERED AND�D% I OR ALTER,RFPAPR.SEWER OR SE LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE _WAG OF E DISPOSAL SYSTEM. CALIFORNIA ALIFORNIA OR THAT I AM 7HE LEGAL OWNER OF, AND INTEND To - RESIDE I ------ N DISCON-NE-T PLUG AND I-, THE ABOVE DESCRIBED RJESIDENTI�,L PROPERTY- ABANDON OUSE SEWER SIGNATURE A-,( BACKFILL SEPTIC TANKS - OF PERMITTE ta' SEEP,PIT(S) D CESSPOOLS UI VALIDATION- ROBERT A. WOOD CK. M.O. CA SUPERVISING MECHANICAL ENGINEER :£HCH IEAv41D APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWED—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION B{/ILDI N JOHN A. LAMBIE. County Engineer AnrREss WILLIAM A. IENSEN. Sup't of Building LOCALITY FOR APPLICANT TO FILL IN 'ms's 5T. - — — -- - - y ."CR IPTION LOT NO. OWNER MAIL BLOCK TRACT !-�!✓'Y"' .. .`'�_fC � ADDRESS NO SIZE OF LOT NOW ON LOT CITY TEL, NO,. US - :E O 'a E)L.t- NGS DISTRICT NO. GROUP MAP PROCESSED BY CONI RACTOR ,r` e` — ADDRESS '.NNECTION DATA - -- -- �u- _ —- -- 1 "9 .' T'IOr..- � DEPTw a� CITY` ,, TEL NO: - _ -- — - -- - - -- nr C sTAr MANHOLE RerFRerac.E �. � jr� REGISTRATION NO COUNTY ....�.. „„ - LOWE.P NO. DESCRIPTION OF WORK FES - - — _ _ TYPE F G(?N1Fy<'i — L..ENGTH FROM HOUSE EW R CONNECTING TO - --- � Y. �^, P.. . M.L TO J6' SEWER 55.00 .-__Z�.6'F_'_ - -9' _ ----- - - - � P.C.NO Sf_P 1;TANK.SEEPAGE-PIT OR ` PI +,NO/OR DRAINFIELD @ $tO.Op - co. IMP NO '� i JOB — ___— ---_ - ._-t HO S_SEWER CONNECTING 70 TRUNK PERMIT NO. ROAD PCRMIT ✓ -� PP V.,TE DISPOSAL SYSTEM. $3.00 ___. _ L..__. A —__ —_ ONNECT A DiTIONAL.BLDG OR AFF I.DAlIT wa.1V R sae CMkNT RECOFSD.iNSIR No, DATE WORK TO HOUSE.SEWER ( $3.0o 1 OVERFLOW SEE FADE PIT.DRAINV ELD F I N.CESSK UOL.DRYWELi_,MA i.OLE $5.00 -.---__ HWY.OR T WIDENING ALTf R.R FAIR OR ABAND(j7, 91USE. tYS 1 53.00 TATE NCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL ' - - CHARGES OVJNEW S PERMIT NEC7t:JN L`HP RC's£ FEE AUTHORIZATION I TOTAL FEE I HAVEAT THIS DATE A CONTRACT WITH, THE.tiERE'.IN NAMED CON- REIMBURSEi•AENTFEE TRACTOR TO r'ON N.ECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBC SFVjFR. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS---,--DAY OF. ;�--_ ----------- ---------_---------j --------- . OWNER OR -. - NEW HOUSE SEWER OWNERS AGENT_—.__,—_—.__ ---_ CONNECT ADDITIONAL ADDRESS BUILDING OR WORK aE.F'TIC TANK.SEEP,P9T(5) I I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APr'LrCATIONI ' AND/OR DRAiNFIELD 1 AND STATE THAT THE ABOVE IS. CORRECT AND AGREE. TO COMPLY 'WITH ALL COUNTY” ORDINANCES AND STATE LAWS REGULATING --�---_�--�_— —'_ PLiiMH1N's AND SEW FRS. CESSPOOL Ell DRYWELL ❑ ! 1 iHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR l_If=-ENSED AS RECU:RED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CA L:FORNfA OR.THAT I AM THE LEGAL O'N NER OF,. AND INUIBCOTEND TO __.._.— NNEC7 PLUG AND RESIDE IN, THE A-BOVFT DESCRIBED RESIDENTIAL PROPERTY, ABANDON!-FOUSE SEW€R SIGNATURE __- ______. OF PERMITTEEy /�.s� ,b's.'"dSACKi�ILL SEPTIC TANKS SEEP. P(TS) [f c Ess POOLS F]� VALMATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK, M.O. CASH h