Loading...
HomeMy Public PortalAbout5664 MCCULLOCH AVE_Sewer__ DEPAWfft[E+NT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1 DIVISION OF BUILDING AND SAFETY _ PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS FOR APPLICANT TO FILL IN LOCALITY BUILDING NEAREST ADDRESS CROSS ST. LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST -- A S CROSS ST. J RECEIVED BY Ready for Inspection DATE ISSUED OWNER MAIL _ ADDRESS USE ZONE OCCUPANCY MAP — � BK PG CITY TEL.NO. CONTRACTOR -- CO.IMP.NO. ADDRESS !OB NO. CITY TEL.NO. -- —y�,- TRUNK PERMIT NO. - C3 / STATE REGISTRAT?ON N0. COUNTY ROAD PERMIT NO. >j _ _ 77 LEGAL DESCR'PTION LOT NO. STATE ENCROACHMENT PERMIT NO. BLOCK TRACT INDUSTRIAL SIZE OF LOT. ' j' N0.OF BlDGS. WASTE APPROVAL , S _ NOW ON LOT CHARGES USE OF BUILDINGS CONNECTION CHARGE FEE NO.) DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING"TO REIMBURSEMENT FEE PUBLIC SEWER Q $ 3.50 RECEIPT NO. I DATE BY HOUSE SEWER CONNECTING TO _ _ PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER GR REPAIR EXISTING NO• DATE i BY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA SEPTIC TANK.SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 STATION DEPTH CESSPOOL—DRYWELL _i SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE UPPER LOWER TYPE OF CONNECTION LENGTH FROM OWNERS ; I 00 Y. CURB P.L. M.L.TO P.L. PERMIT AUTHORIZATION I TOTAL FEE I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE SIGNED THIS..........---------DAY OF: ..................... ...1 NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT._. ....._ ------- BUILDING OR WORK ADDRESS................_........................ _._......_..._ SEPTIC TANK,SEEP.PIT(S) _........_...---.---.-...._--.------ AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL E] CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND DISCONNECT PLUG AHD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS y, SEEP.PIT(S)0 CESSPOOLS SIGNATURE :�Ao--!s' - � OF PERMITTEE._-...:. r_._.....�.__._...._ - ....................... 76a692D 663 1/53 • BA64ED ca©aaa•sc APPLICATION FOR PERMIT . COUNTY OF LOS ANGELES SEWER--SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LANIBIE, County Engineer ADDRESS CASSATT D. GRIMN,Supt of Building _LOCALITY NEAREST FOR APPLICANT TO FILL IN __smR s ST. LEGAL _DESCRIPTION LOT NO, OWNER `— BLOCK TRACT MAIL ADDRESS - - NO,OF BLDGS. °' SIZE OF LOT NOW ON LOT CITY. TEL,NO. USE OF BUILDINGS DISTR{CT NU. GROUP MAP PROCESSED BY BK PG CONTRACTOR ADDRESS CONNECTION DATA CITY TEL.NO. STATION DEPTH �] STATE UPPEF, REGISTRATION NO, ❑ COUNTY MANHOLE REFERENCE _ — NO. NO. DESCRIPTION OF WORK FEE LOW€R FE SEWER CONNECTING TO C SEWER @ $3,00 TYPE OF CONNECTION LENGTH FROM C TANK.SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. RID/OR DRAINFIELD @ $3.00 _. LOW SEEPAGE PIT, DRAINFIELD ,CESSPOOL,DRYWELL,MANHOLE @ $2.00 _ SEWER CONNECTING TO P.C. NO. TE DISPOSAL SYSTEM @ $t,00 --CO.IMP.N0. JOB N0. ECT ADDITIONAL BLDG,OR TRUNK PERMIT NO. ROAD PERMIT NO. TO HOUSE SEWER - $1.00 _ _ , REPAIR OR ABANDON HOUSE STATE ENCROACHMENT OR DISPOSAL SYSTEM @ Sim PERMIT NO.INDUSTRIAL,WASTE APPROVALCHARGES ERS PERMIT �$ 2 O® ^CONNECTION CHARGE FEE AUTHORIZATION UTOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE. ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER OWNER OR CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK - - SEPTIC TANK,SEEP, PITS) - ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL[I DRYWELL[I WITH ALI. 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 �a LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE CT PLUG AND OF ABANDON CT PLUHOUSE SEWER CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THZ=ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL—SEPTIC TANKS Q SIGNATURE SEEP. PIT(S) CESSPOOLS[] - -- OF PERMITTEE ` VALIDATION ROBERT A.WOOD CB: M.O. CASH SUPERVISING MECHANICAL,ENGINEER