HomeMy Public PortalAbout5642 1/2- 5644 MCCULLOCH AVE_Sewer__ ]/��
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6A6.A20 63 APPLICATION CA`l°ION FOR PERMIT :
COUNTY OF LOS ANGELES 9
DEPARTMENT OF COUNTY ENGINEERSEWER-SEWAGE
BUILDING AND SAFETY DIVISION SU!LDING
JOHN A. LAMBIE, County Engincer ADQREss
WILLIAM A. JENSEN, Sunt of Building py +
LOCALITY
NEAREST
FOR APPLICANT TO FILL. IN CROSS ST
r LiJ(h U E' d"NER
O'S
F_SCRIP.ION__ ,__ ._ -___ __-._ �-i@ _ P✓" y`L __-_.
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rd NOSIZE
OW OLOT �dOfLe : 4
USE OF � G �` "-�''• :.
BUILDINGS C;STRICY NO. GROUP MAP PROCESSED BY
SK F �e
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CONTRACTOR
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ADCREssr ''} !% ;- CONNECTION DATA
STATION ^ DEPTH
TEr_. Nc. �� �+ �.�'�� _ ��r
STATE `
REGISTRATION. NO COUNTY MANN OLS.REEERE NCE + 9 � -!.^ '..._
NO. ! DESGRIP7IQN OF WORK FEE --- --. -- - ....
TYPE Or CONNECTION LENGTH FROM
! HG ISE-SEWER DONNE-:TING 70 � Y. CURB P.L. M.L.TO P.L. -�
PUBLIC SEWER $5.00
�i PITS ANSI JR DRAIJFIELD7 CyR-.— S O.bb _- - CC).-IMP �OB N('7
HDA SFW R. irNNE iINCc TO TRUNK PERMIT ROAD PERM 11 NO.
CORNETT ADDI TONAL BLDG OR ' 3:00 .AFF(DAYI7 waly[rz en•�cf!cn`r:, RECURJ 'NSYyr'N t3: +DATE
R V D SPOSAL S(fn Cas @
�OVE.RF LOW'SEEPAGE.PIT,DRAINF i£;LD
EXTN.CESSPOOi,,DRYWELL,M NHOLE 0 3500
ALTE77�tYeP*.�&-Qr`d.ABANDON HOUSE------------�-- ----- HWY. JR S7 WIDENING - •4 F
r'
j S W R,k'3R-9YSf�&AY3�1';-M @ $ .b0
7- .,@-� ___ ...____ _______�. .I,.-__. STATE EN RO.ACHME>
PERMIT NO
...- !NQU STRIAE
J w
.... � .� —� WASTE Af UYA
79
+�OWNER'S PERMIT $ 21 00 CHARGES
--- ---
AUTHORIZATION HORIZATION TOTAL FEE .O',_ E("T'ION CHARGE FEE'
'I HAVE A7 THIS DATE A CONTRACT WITH THE HFREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED s-EbX—I—STING DW ,EF -N
70T ! APPROVALS- ----- ----�— --TE-�IS-E--C-
TOR S SIGNATUREHE UFil SEWER.
SIGNED THIS DAY —
----
OWNER OR Jy°' .,''j � NEW HOUSE SEWER I
OWNERS ACE*tT zlz
CONN ECY ADDIT ONAL
L
BUIDING OR WORK
ADDRESS ! 4y L _ _�Y�,,m sY _ _ ----_ `-F- ----- ------
jF� GEPri':TANK,SEEP,PIT4S)
I HEREBY ACKNOWLEDGE THAT I HAVE AD THIS APPLICAYIO•N ANCi OR CJKAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
W ITN ALL COUNTY ORDINANCES AND STAT£ LAWS REGULATING
PLid MBING AND SEW ER,e. CESSPOOL El DRYWELL ❑
I HEREBY CERTIFY THATI AMPROPERLY RE0I5TE.RED AND/OR ALTER,REPAIR,SEWER,OR
LICENSED AS RF..OUIRED SY LOS ANGLE'S COUPJT'Y AND STATE OF SEWAGE WS.PC:SAL SYE-:T'EM
CALIFORNIA'0R THAT I AM 7'�Hy�E LEGAL OWhiER CF. AND INTEND TO D15CONN ECT PLUG AND
RE SIDE IN. THE ABO tfT 8 D RESIDENTIAL PROPERTY.
,Tf ,s'`�-f" � ABANDON HOUSE SEWER �
SIGNATURE j' -
F PERMITTEE �` ,~• - ''�'` BACKFILL £F'7!C TANKS.
O
— --._ ,��:T�._ _ �- uE-EP.PIF(51 T'
4J CESSPOOLS
-VALIDATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
-`C K. M.O. CASH
6A642o 0-63
ar;azAPPLICATION FOR PERMIT �
COUNTY OF LOS ANGELES SEWER—SEWAGE 01SPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FAD
DING �� 1 t t
JOHN A. LAMBIE, County Engineer Ess - ,�.5!�' _ Y_-_WILLIAM A. JE:NSEN. Supt of Build ngL TYEST
FOR APPLICANT TO FILL IN045
LE AL
pESCftlPTION LOT NO
__
9..00K TR4CT n-:2 I'll, � ADDRESS _y ( 9.t3'J -'='Yd'' - 'C�+11'•`y
NO. OF- PLDsS.
SIZE O UY 40'JY ON LOT CITYCISTRICT N� � T.L.
USE O /r/, _ _
USE C NGS + OUP MAP P jo<' SSED BYBUI
- _ _ BK FG r
CONT
RACTO I a f rrr- d _,-�•'r`ILK,ti v
ADDRESS "�< _'� .�' r CONNECTION DATA-- n --
,✓�C.,�1p.�,�r:'_.,sSTATION DEPTH
CITY ._ EL NO',�,. r. -=a
y r' Sl ATE MANHOLE REFERENCE J UPPER
REGISTRATION
NO. LI COUNTY ,/tom• �1.O�fJER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH4FROM
HOUSE SEWER CONNECTING`!'O Y, CURB - P.C.: M.� O P.L.
PUBLIC SEWER SS.Go
-_.__. P.C.NO. �-
SEPTkC TANK.SEEPAGE PITOR - aa,
i PITS
AND/OR ORA.INFIE:;LC @ 5.1000 e;0.IPn,P. NO. JOB NO. j
HOUSE SEW Eft CONUECYING YO TRUNK PERMIT NO, ROAD PERMIT NO.
PRIVATE t PCSAL SY -EM C $3.00 C- AFFIDAVIT
� NNEGT ALGi I CONAL BLCC OR AFF!DAti 1, Y wNiYE eas ENEwi�fRECO RD..NS R NO. DATE
-WORK TO HOUSE,SEWER $I CIO
kTN CESSPOOL,DRYV EE_.L:MANHOLE
..__ —-
_— ____ _.- - HWY.OR a'7 WIDENING •� r' �"'y��'✓�'"�
r
_.
'�AL7ER.REPA4 R OR ABAtdp ON HOUSE
S
EWER OR DISPOSAL SYSTEM @ 53.00 I - _ __
—, - --7- STATE EN CROACr�MENT
PERMIT NO
INDUSTRTAL
WASTE APPROVAL
OViNERFS PERMIT $ 2 00 CHARGES
AUTHORIZATION TOTAL FEE — -- ✓gym 's CONNECT ION_nRGEFEE ---_ -- --
REIMBURSEMENT FEE
'I HAVE A7 THIS GATE A CONTRACT WITH THE t1ERE1N NAMED COPi- ----q-'yp—�--/y
TRRCTOR TO CONNECT THE ABOVE DESCR BED EXISTING DWELLINSE --'-- APPROVALS
TO Ti4E PI:BLL S`W ER. DATE iNSPEC70 P.'S SIGNATURE
SIGNED T'H E S Y C F. _ _ P 9,_._ ----- -----r - ---� .--- -------
OWNER OR 1 NEW HOUSE SEWER
OWNERS AGENT.,
..-� -- CONNECT ADDITIONAL
s BUILDING OR WORK
-- -
SEPTIC TANK,SEEP P!T(S)
I HEREBY ACK':