HomeMy Public PortalAbout5010 DALEVIEW AVE_Sewer__ DEPARTBIElNT OF COUNTY ENGn SEWER—SEWAGE DISPOSAL472 3
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES `
WILLIAM*J. FOX, COUNTY ENGINEER I AGGRBUILDING ✓ ^^L� v���
ESS
FOR APPLI T T HLL IN LOCALITYBUI6L /`1D�YTi�
ADDREISNO n GGROSS ST ,/�'. G'�ikif0,0 (/f
LOCALITY DISTRICT NO. Raptly for Inapeetion PERMIT N0.
NEAREST 1 � 1 J
CROSS ST.
RECEIVED BY DATE ISSUED BY, GATE
OWNER t"
MDDRESS AIL �E OCCUPANCY BK MAP PB
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CITY TELNO. .� �0O lea,_
CONTRACTOICallf OPnla Sewer ORS • O•
' CO.IMP.R0.
ADDRESS 1317 Colegrove Ave.. _
JOS.N
CITY Montebello TEL No /
TRUNK PE T NO.
REGISTRATION N0104445 COTUNTY
ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACTINDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BLOGB.
NOW ON LOT ARGES
BUILDINGS CONNECTION CHAR FEE .J
NO. DESCRIPTION OF WORK FEE
REIMBURSE TFEE
H OUSE SEWER CONNECTING TO J\
PUBLIC SEWER Q S 3.00 / [J REC TNO. I DATE IBY
HOUSE SEWER CONNECTING TO ..
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_ WORK TO HOUSE SEWER 1.00 _
ALTER OR REPAIR EXISTING NO' I DATE IBY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND SEWER
ABANDON
100 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR J�
_ PITS AND/OR GRAINFIELD 2.00 STATION /. DEPTH
CESSPOOL—ORYWELL
SPECIAL CONDITIONS ONLY 2.00 MANFERENCE
Qom{' �tleBEHOLE REFERENCE
OWE
- TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT f 1 00 � P.L. M.L.TOP.L .j.,T7
AUTHORIZATION TOTAL FEE
1 IN HAVE THIS DATE CONTRACTED WITH THE HER NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO�J PUBLIC SEWERff,�� /
SIGNED THISt- _ __DAY OF_` l ._.�1� NEW HOUSE SEWER SGS,y 11Y /]-,Ti
OWNER OR CONNECT ADDITIONAL
OWNERS AG(E�N/Tq.._.. /(�_� Q � BUILDING OR WORK
ADDRESS.-V,l..Y._. . _24A
.. .._... - AND/ OR GRAINFIELD IT(8)
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS PLI• CESSPOOL[:) DRYWELL
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 REPAIR.
DISPOSEWERAL R
1 HEREBY CERTIFY THAT IAM PROPERLY REGISTERED
ANO/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
A N D STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DJ:BOB DED SIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS 0
SIGNATURE L/r��- / /II/ BEEP.PIT(B)[3 CESSPOOLS
OF PERMITTEE
76A642D S&S 663 4/54 d