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DEPARI'AMNT OF COUNTY ENGINEER l SEWER—SEWAGE DISPOSAG 42 ti
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION \
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COUNTY OF LOS ANGELES I
NG
WILLIAM J FDX COUNTY ENGINEER f I ADDRESSffG
LOCALITY
FOR APPLICANT TO FILL IN " 0&
BUILDING NEAREST r
ADDRESS CROSS ST �
LOCALITY DISTRICT NO SERIAL NO PERMIT NO c
NEAREST A TRY D S
CROSS ST ef t '
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRESS USEZONE OCCUPANCY MAP
BK PG
CITY TEL NO DJ�L(�
CONTRACTOR Call-torn,a gel.yqpn � CO IMP NO
--vvIIS�" 0 77
ADDRESS
-1317 COIPgrOyg Ave.
JOB NO
CITY Montebello TEL NO TRUNK PERMIT NOSaLWAIR
1
REGISTRATION NO 104445OUNTY ROAD PERMIT NO
LEGAL f STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK A TRACT Ila 4? 7 INDUSTRIAL
WASTE APPROVAL t
SIZE OF LOT NO
NO OF BLDGS
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION GE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 350 RECEIPT NO DA BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDB OR X PTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING O 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 200 STATION �D�-3 3 DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 r /� AN EFERENCE
J PPE E$
TYPE OF CONNECTIO ENGTH FROM ��♦
OWNERS PERMIT $ 1 00 Y CURB Pt. ML 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/PUBLIC SEWER
SIGNED THIS / DAY OF(/J'! � Iq � NEW HOUSE SEWER
OWNER OR -� - - CONNECT ADDITIONAL
OWNERS AGENT [¢ BUILDING OR WORK /
ADDRESS SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL F] DRYWELL
CA
TIONAND 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
I 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 TH T I AM THE LEGAL OWN
ER OF THE ABOVE ESCR ED R IDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SEEP PIT(8)E] CESSPOI
SIGNATURE
OF PERMITTE
n
76A642A 663 7/53 AMP"'. ®A /jam i-L � �
D
S&E 6 f `69 if SS APPLICATION FOR PERMIT
3E 8
'DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DIS SA L
Department of County Engmeer
County of Los Angeles BUILDING
JOHN A LAMBIE COUNTY ENGINEER ADDRESS /
® CASSATT D GRIFFIN SUP T OF BUILDING LOCALITY .�
FOR APPLICANT TO FILL IN CROSS ST
LEGALLl
DESCRIPTION LOT NO OWNER
MAIL P/
G,.,�I 9 I
BLOCK A TRACT / / ! l 7 ADDRESS 7/+'Yt•/
11//N�O OF BLDGS CITY TEL NO
SIZE OF LOT TROW ON LOT
USE OF
BUILDINGS DISTRICT NO GROUP MAP I
BK PG
CONTRACTOR � /�L v/ 6x /Z/
CONNECTION DATA
ADDRESS
NO
CITY TEL P STATION DEPTH
i �—
� � ��f � MANHOLE REFERENCE UPPER
LOWER
REGISTRATION NO
/ e2 [ICOUNTY
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
Y CURB PL ML TOPL
PUBLIC SEWER, @ $3 50
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3 00
OVERFLOW SEEPAGE PIT DRAINFIELD P C NO
EXTN CESSPOOL DRYWELL MANHOLE @ $2 00 CO IMP NO JOB NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1 00 TRUNK PERMIT NO ROAD PERMIT NO
CONNECT ADDITIONAL BLDG OR STATE ENCROACHMENT ' 1
WORK TO HOUSE SEWER @ $1 00 PERMIT NO 41 1 +
ALTER R HOUSE /Y/J INDUSTRIAL
SEWER Qa4N4?6bfi-eSYSTEM @ $1 00 (/ V WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER S PERMIT $ 6 00
REIMBURSEMENT FEE
AUTHORIZATION I TOTAL FEE `3
APPROVALS DATE INSPECTOR SSIGNATURE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTICTANK SEEP PIT(S)
ADDRESS AND/OR DRAINFIELD
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 p
PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM k
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM TH LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT PROPERT I // BACKFILL SEPTIC TANKS[:1SIGNATURE L SEEP PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE � �✓
JOHN A LAMBIE COUNTY ENGINEER �T ,LIDATION ROBERT A WOOD CHIEF PLBG INSPECTOR
CASH
Lflro 5 96 3 OCT 2 210 A 3 00