HomeMy Public PortalAbout9038 CALLITA ST_Sewer__ 6 E-66 APPLICATION FOR PERMIT
a�BGDIVISION OF BUILDING AND SAFETY SEWER SEWAGE DISPOSAL
Depaxlmpat of County Engineer l
COaatf OI Loa AagBIBe ADDRESSG \,\
WM. J. FOX,COUNTY ENGINEER ,
CASSATT D. GRIFFIN.SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN NEAREST
CROSS ST. �j�.vA/liL_.s0
LEGAL
DESCRIPTION LOT NO. ^ OWNER
BLOCK TRACT v� ADDR 11.
E55 e•i10..�L.�:i i
CQ NO.OF BLDGS.
SIZE OF LOT ✓ HOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO I GROUP MAP
BK PG
CONTRACTOR CALIF.SEWER CONST.CO. _1)
ADDRESS 1 1317 COLEGROVE AVE. CONNECTION DATA
CITY MONTEBELLO TEL. NO.PA. 1-5048 STATION '�'it— 322 0 DEPTH
❑ STATE / /y/ANHOLE REFERENCE
REGISTRATION NO. 1486C 59p �y
(STATE) ❑ COUNTY U/ UPPER
TYPE OF CONNEW 10 LENGTH FROM /J LSI
NO. DESCRIPTION OF WORK FEE Y. CURB L. M.L.TO P.L. /C�7
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q S 3.50
HOUSE SEWER CONNECTING TO
.PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. (�
WORK TO HOUSE SEWER 1.00 J O .IOD. N0.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
_ AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CH ES
-- CONNECTION CHARGE FEE
OVINER•S PERMIT S 1 00
AUTHORIZATION TOTAL FEE REIMBURSEMENT FE
MED CON-
TRACTORTTOG CONNECTTHEI HAVE DATEAABOVE DESCRBEDWITH THEH EREIN EXISTING DWELLING APPROVALS VATE it,NSPECTOR'S SIGNATURE
TO THE PUBLIC SEWF-7� J
SIGNED THIS r7--DAY OF ^ 1� NEW HOUSE SEWER */Xt� .�y,.r( LG
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT ° A A„ BUILDING OR WORK
C SEPTIC TANK, SEEP, PIT(S)
ADD0.F55 AND/ORDRAINFIELU
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ECT PLUG AND
ONN .
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
ON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PRO RTY. BACKFILL SEP TANKS
EF.
PIT ❑ /
- SCESSPOOLS
SIGNATURE V
OF PERMITTEE
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION
_RCo7 0 7 AUG23 4 4.50
BY BY — .-
DEPUTY_ DEPUTY
BY BY // I/
® DEPUTY DEPUTY�/y