HomeMy Public PortalAbout10740 FAIRVIEW AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL1
DIVISION OF BUILDING AND SAFETY ( PERMIT APPLICATION34181
COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER 1' BUILDING ADDRESS/p/�f +� �c ,/
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FOR APPLICANT TO FILL IN LOCALITY ,�,e
BUILDING NEAREST '
ADDRESS / / CROSSST All e/Ar SIe/�J
LOCALITY" i DISTRICT NO SERIAL NO PERMIT NO
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NEAREST �,
CROSS ST + i A
S RECEIVED BY Ready for Inspection DATE/I//SSUED v
OWNERMAIL
ADDRESS L USE ZONE OCCUPANCY MAP
BK PG
CITY TEL NO I
CONTRACTO(e,-t 1, f crnia Sewer f!on-.t.GO- 1 co IMP No
ADDRESS 1317 Colegrove Ave,. JOB NO\
CITY Montebello TELN0loriTRUNK RMITNO
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REGISTRATION N0104445 Sta O%UNTYI
ROAD PER IT NO
LEGAL STATEENCR ACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT D i INDUSTRIAL
WASTE APPRO L
SIZE OF LOT/DQ NO OF BLOCS X D U
USE OF NOW ON LOT ' C RGES _
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BUILDINGS_ A CONNECTION CHAR\E E ?
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT
PUBLIC SEWER Q ; 3 50 D RECEIPTDATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EX EPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING NO I DATE 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 200 STATION � DEPTH
CESSPOOL—DRYWELL r—
SPECIAL CONDITIONS ONLY 2 00q f MANHOLE REFERENCE
2z UPPER 1,0iYflih
TYPE OF CONNECTION LENGTH FROM y
OWNERS PERMIT Z1 I 00 I _y_ cues P L M L TOP L
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN* NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE Y
LIC SEWER
SIGNED THIS DAY OF _ 19 NEW HOUSE SEWER
OWNER OR ). ll - i CONNECT ADDITIONAL
OWNERS AGEJNT `7Q.L(lf _ BUILDING OR WORK
ADDRESS �C I D - SEPTIC TANK,SEEP PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL❑ DRYWELL C]
'AT
IONAND 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 DISCONNECT PLUG AND
AND/OR LICENSED-AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABO'V-EIDESCRIBEDDL_WA��
RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE //�` (- SEEP PIT(8)� CESSPOOLS�
OF PERMITTEE "' - � G /dam- ✓�'
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