HomeMy Public PortalAbout5640 MCCULLOCH AVE_Sewer__ •6A
E-669 SS.55 APPLICATION FOR PER-MIT 1
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING,)—.,
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JOI-i1V A. L_AMBIE, COUNTY ENGINEER ----- �-,^`, -----
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITYNEw
------FOR APPLICANT TO FILL IN -cre sT`
- LEGAL _ - OWNER A`
DESCRIPTION LOT NO —._ _
----- --- -MAIL
BLOCK TRACT -_ADDRESS_ _,--. ---
No, OF BLDG9.
SIZE OF LOT ✓` NOW ON LOT „•; Y CITY TEL NO.
USE OF �----�---
_BUILDINGS :<:" L( ;, T DISTRICT NO. GROUP MAP
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CONTRACTOR. t tom. l f fo. � �------------
ADDRESS CONNECTION DATA
_� r _STATION _ �- _ DEPTH
_Cj -. l_ - - MANHOLE REFERENCE -C^ UPPER
_ ❑ STATE i._. LOWER
REGISTRATION NO. q ❑ COUNTY -
-
NO, I DESCRIPTION OF WORK y FEE ---- -.----- -- -- ----
HOUSE SEWER CONNECTING TO Y; J, Y TYPE OF 'tCTION LENGTH FROM - ,-
PUBLIC SEJJER _ $3„50 URB P.L_, M.L. TO P L
J
SEPTIC TANK SEEPAGE PFT OR ,,'.p- '-
PITS ANDiOR DRAINFIELD r $$3.00 -,.•r P `L ..+-tt"'r' -S'
OVERFLOIV SEEPAGE PIT,DRAINFIELDP. C. NO.
..
-_ C`C]N CESSPOOL„DRY4VELL,MANHCLE r�i $2.00JOB NO,�—(- CO, tMP. NO. ;' � -_
HOUSE SES"/ER CONNECTING TO -- -- I --- -- ,
PRIVATE DISPOSAL SYSTEM: ��� S 1.00 _-�— TRUNK PERMIT NO, ROAD PERM17 N0.�f��^� �+� �
CONNECT ADDITIONAL BLDG OR - _•-� STATE ENCROACHMENT
_
WORK'TO HOUSE SEWER (q� $1.00 `= PERMIT NO.
J ALTER,REPAIR OR ABANDON HOUSE --
INDUSTRIAL - -
SEWER OR DISPOSAL SYSTEM 06 $1.00 WASTE APPROVAL
CHARGES
-- --- _ .------ - -L--_---i� ----
CONNECTION CHARGE FEE
OWNER'S PERMIT ��_a I Ori -- -- — -- --
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE �.%s .
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN .AHED CON- APPROVALS � DATE INSPECTOR'S SIGNATURE
TO CT PUBLIC SEWER.
DWELLING -I -
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING NEW HOUSE SEWER I
SIGNED THIS— DAY OF_---._ —19-.`
CONNECT ADDITIONAL
OWNER OR 's BUILDING OR_WORK - - --�-._-- _ .---- --_--- --.,
-I
OWNERS AGENT----1,... - - SEPTIC TANK,SEEP,PFT(S)
ADDRESS AND/OR DRAINFiELD
I HEREFY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION - - I
AND ST,nTE THAT THE ABOVE IS CORRECT AND AGREE 'i0 CUM PLY' CESSPOOL Lj DRYWELL❑
_._.. __ ..- _. - --' ---------4.----------
WITH
_._WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR I
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM_
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ----r--"-
LICENSE:D .AS REQUIRED 'Y LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG 4ND i 1
R+ ABANDON HOUSE SLWEP. 1
CP,J(..IFORi•II.A OR THAT I *M THE LEG:.L 'C1WNEsS2�OF THE ABOVE --- -..--- ----� - -- -- ----�-- .- ----
SEEP. PIT TSI Li T TANKS❑ .-."
SIOGSCAIBFD RESIDENTIAL
SIDENTIAL PRIOPERTY. 1 _ / BACKFILL SEPTIC
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JOHN A. LAM I , COUNTY ENGINEER VIALIDATIO ROBERT A. WOOD, CHIEF PL6G. INS51E4.TOR
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