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Home My Public Portal About5626 MCCULLOCH AVE_Sewer__ a E. 9 12�5� D 5APPLICATION FOR PERMIT 1 S&E-66 DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL Department of County Engineer County of Los Angeles BUILDING WM.J. FOX, COUNTY ENGINEER ADDRESS CASSATT D. GRIFFIN,SUP"r OF BUILDINGLOCALITY FOR APPLICANT TO FILL IN CNEAREST ROSS ST. LEGAL DESCRIPTION LOT NO. BLOCK ,,r.,..r TRACT _ MAIL --� - _ ._.._. .._._.._.._... .:. .. ADDRESS 140. OF BLDGS. - SIZE OF LOT �^_NOtS+ON LOT - _ CITY - TEL. NO. USE OF� -- _BUILDINGS - _ DISTRICT No. GROUP MAP SK PG CONTRACTORLx__ `S — _ ADDRESS CONNECTION DATA CITY I` _ No. STATION -,c DEPTH El STATE lsAN�!_L.E REFERENCE REGISTRATION NO. COUNTY ' - TYPE OF CONNECTION �- AENGTH FROM . CURS P. NO. I DESCRIPTION OF WORK FEE YF. M.L.TO P.L.� .c- _. __-- �_.i HOUSEScWER GONNECT:NG TO ii � ,UBLIC SEWER @� $ 3.50 I { e —.--- - HOUSE SEWER CONNECTif4G TO 1 PRIVATE DISPOSAL SYSTEEd_ 1.00 - ^� CONNECT ADDITIONAL BLDG. OR �' JOt NQ. WORK TCO. IMP. NO. S'0 HOUSE SEtiVER 1.0 CO.{� I ... — - '�- .__ ALTER ORREPAIR E}.i5'T1NG 5144 ER OR DISP{75 AL vYS?£M TRUNK PERMIT N0. ROAD PERMIT NO, 7 00 DISCONNECT AND ABANDON SE i`ER AND'OR DISPO-.AL�fSTFM 3.00 i STATE ENCROACHMENT PERMIT NO. - SEPTIC TANK,SEEPACI PIT OR I - - _ PITS AND/OR DRAINFIELD 2.00 ! INDUSTRIAL - CESSPOOL 'WASTE APPROVAL- - --------- - -" SPECIAL COND TONS ONLY - 2.00 I -"i;HARGES OWN'ER'S PERMIT — — 11 00 CONNECTION CHARGE FEE — AUTIORIZATION TOTAL FEE 1A� REIMBURSEMENT FEE I. NAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIDEED EXISTING DVVELLI^.C- TO THE PUBLIC SEWERNEW HOUSE SEWER SIGNED THIS —DAY 17 OWNER OR - CONNECT ADDITIONAL - OWNERS AGENT- --�� _ _ _ _BUILDING OR WORK _ ACDRE58.� SEPTIC TANK, SEEP, PIT(S)' AND/OR DRAINFIELD +� I HEREBY- ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL AND STATE THAT THE ABOVE IS CORRECT.AND AGREE 7'0 COMPLY 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 ` LICEN5ED AS REQUIRED BY LCS ANGELES COUNTY AND STATE OF ABANDON HOUSE PLUGAY _ CALIFORNIA OR THAT. I AM THE LEGAL OWNER OF THE ABOVE -_ .._._. _ .��. ...-.-- .-. DESCRIBED RESIDENTIAL PROPERTY, BACKFILL SEPTIC TANKS C7 SEEP.PIT(S) ❑ CESSPOOLS - SIGNATURE OF PERMITTEE - WILLIAM J. FOX, COUNTY ENGINEER VALIDATION JUN 16 4 55 BY BY DEPUTYf 1, "per DEPUTY BY BY �.e. 0 DEPUTY �.+� DEPUTY t s:- - 246 5V INSERTS` " 6E6086. 7£A642Q 60 APPLICATION ION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION F±NA I®IIN A. LAMBIE, County Engineer WIL&IAIyL A IENSEIS.Supt of Building FOR APPLICANT TO FILL IN 277 LEGAL -7 • >v OWNER ' . ' ,Y . DESCRIPTION LOT N0. BLOCK TRACTy� „ MAIL /'tel �J `� ..— -�j _ ADDRESS N0.OF BLDGS. ,a SIZE or NOW ON LUT CITY TEL. NO. USE OF F. 0 RQ CESSED BY - BUILDINGS DISTRICT N0. GROUP MAP PBK PG CONTRACTOR ADDRESS CONNECTION DATA CITY a°` r TEL.NO ✓ STATION DEPTH �+ TS ATE UPPER REGISTRATION NO. COUNTY MANHOLE REFERENCE _ LOWER NO. DESC'.RIPTION OF R. F a 4 -- H $-E SEWER CONNECTING TO . --. -- _ PUULIC SEkYER C 53.00 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK.SEEPAGE PIT OR Y. CURB P.L, M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT;DRAINFIELD —i EX N..CESSPOOL, DRYWEL L. $2.00 HCuSE SEWER CONNECTING TO - P.B O. _I PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP. N0. JOB NO. ¢DDa ZONA'BLDG,OR —TRUNK PERMIT NO. „,` Ail PERMIT N0. 0 WDR TI) H01 SE SEWER. � $1.00 U Ai F'R. REPILIR OR 15A1dD1N HOUSE .STATE ENCROACHMENT 5 WCR OR DiSnOSAI.SYSTEM @ $1.09 PERMIT NO. 94C INDUSTRIAL- 1. 1_- - 2 WASTE APPROVAL w CHARGES 0 OWNER'S � PERMIT $ 2 00 CONNECTION CHARGE FEE AUTIYORId'ATiON TOTAL FES "'w' REIMBURSEMENT FEE I 14AVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE AB VE DESCRIBED EXISTING DWELLING. APPROVALSDATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS D OF 19— NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT — BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP. PIT(S) ---- AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE, TO COMPLY CESSPOOL 0 DRYWELL WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR N FLUMAtNG AID SEWERS. SEWAGE DISPOSAL SYSTEM I H:ER PB CERTIFY THAT I AM PROPERLY REGISTERED ANA/OR DISCONNECT PLUG AND Li CENSE AS REQUIRED BY LOS ANG" S COf1NTY AND STATE OF ABANDON HOUSE SEWER CALfFOR. 1 OR THAT I AM THE L'G L OWNER OF THE ABOVE DESCRtb�D AES .TIAL PROPER'T'Y. BACKFILL.SEPTIC TANKS Cl S"EP.PIT(S) [I CESSPOOLS ❑ SIC,NATU E OF PER ITT£E VALIDATIOa..—. ROBERT A. WOOD C& X.o.. CASH - SUPERVISING MECHANICAL ENGINEEk u � .