HomeMy Public PortalAbout5618 GRACEWOOD AVE_Sewer__ DEPAIClindOMW OF OOUNTY ICNGINZZIL SEWER-SEWAGE DISPOSAL 1
. PtVUION OF BUrLDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGEZJ!!9
WILLIAM J. FOX, CoLIHTY EHOINECR ADDRESS
FOR APPLICANT TO R IN LocALrrY
BUILDING KA REST
AD RESS C►�
.� Y
O ROSS ST.
LOCALITY O DIwmOT NO. SERIAL NO. / PEVII NCL
NEAREST — A 69 fl S
-CROSS BT. ,
EIVED����1��'' Rwq fir lapsed as DATE IISSUKDq
OWNER bu)vIdu� C " SJ!
PAIL US[ZONE OOCUPANQY MAP
ADDRESS '—s � .Q r BK pa
CITY TEL.NO. /� — I .
GONTRAOTDRCalifornia Su . Ier Const.cDco up.No. /
ADDRESS 1317 ColeErove Ave. JOB No. ----��
CITY Montebello TELNWiQn l..B()48 TRUNK PERMIT NO.
REGISTRATION NO.104445 StjtjWUNTY
ROAD PERMIT N0.
LEGAL � a / ENCROACHMENT
DESCRIPTION LOT MO. ? STATE ENC
�" (J C/'T PERMIT N0.
BLOCK TRACT INDUSTRIAL
SIZE OF LOT k?tjM0.OF BLDGS WASTE APPROVAL
NOW ON LOT CHARGES
USE OF
BUILDINGS , CONNECTION CHARGE FEE
�yaNO. DESCRIPTION OF WORK FEE REIYBUREEM E
HOUSE SEWER OONNECTIN TO +yy
PUBLIC SEWER • i 5-60 V RECEIPT H0. DATE BY
SE SEWER WNNEOTIWQ To
PRIVATE DISPOSAL SYSTEM IAO
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECO
WORK TO HOUSE SEWER 1.00
REPAIR EXISTING NO DATE
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AMD OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
A PAG PIT OR
PITS AND/ORDRAINFIELD 21" STATION DEPTH
C POOL LL
SPECIAL CONDITIONS ONLY 2-00 /4//_ NUHOLE R
PPER EFERENCE
TYPE OF GONNE&JOS, LENGTH FROM
OWNERS PERMIT $ 00 --QURM M.L.TO PA_
AUTHOREZATION TOTAL FEE _26-D
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 SEINER
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER ` ; _-Z
OWNER OR CONLIDINB OR ADDITIONAL
OWN
ERS %T RK,
ORK
ADDR A D/OR DRAINF FIELD
IT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] 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 DISPO�AL SYSTEM
I HEREBY CERTIFY THAT IAN PROPERLY REGISTERED DISCOMN60T PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
' ER OF THE DEgC I ENTIAL PROP[Ry�Y. OTANK ❑
SIGNATURE
n C SK ❑ C[SSPOOLB� 1 L
OF PERMITTE
TOd645D 005 1/M �n
C[808 12-05
7EA E42D _ APPLICATIONS FOR PERMIT 710
COUNTY OF LOS ANGELES SEWER-SEE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFTTY DIVISION UNU
p
JOHN A. LAMBIQ. COUNTY ENGINEER
COLEMAN W. JENKINS, SUr'T. OF BUILDING -� O'
l./
FOR APPLICANT TO FILL INLKOAL
�_
DESCRIPTION LOT NO. OWNER S
BLOCK TRACT �� ' ADDI RESP y
Z L
NO. OF ■LDOM.
SIZE OF LOT NOW ON LOT C TEL NOUng . O O
ouILDINGS OF DISTRICT NO GROUP MAP PROGLsm BY
BUI
� FG
CONTRACTOR S� D g /y 5
ADDRESS CONNE=ON DASA
STATION DErTH
CITY TEL NO.
STATE LK MANHOLE R ENCS LOWER
LICEN/[ NO, Ci_ASB
NO. DESCRIPTION OF WORK PEE TYPE OF Co ECTIONLENGTH PROM
E
HOUSE SWKR CONN[ NO TO Y. CU P.L-
M.L.TO P.L
PUBLIC SEWER a $5.00
P.0 NO.
asiIC TANK MIMPAdIKPIT OikCO.IMF.NO. JOB NO.
FITS AHD ORDRAINFI[LD 0 110.00
HOU BE SEWER CONNECTING TO TRUNK FIRM IT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM 41 f3.o0
CONNECT ADDITIONAL RLbQ.OR AFFIDAVIT EAIrn WAOPE ORD.INfTR.NO. DAT[
WORK TO HOUSE■EWER 0 33.00
OVERFLOW SEEPAGE PIT.DRAINFIELD
EXT N..CX"POOLDRYWELL MA NH OLE 0 $3.00 O
3 Qa HWY. OR ST.WIDENING
DI/POfAL rrfrEll 7.00 /TAT[ENCROACHMENT
PERMIT NO.
INDU'TRIAL
WAST[APPROVAL
CHAROO
OWNEE'S PEHMIf $ 200
ADTHOETLATION TOTAL FU OV CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CORTRACT WITH THE HEREIN NAMED-CON. REIMBURSEMENT PEE
TRACTOR TO.CONNECT THE ASOVX DCBCRI APPROVALS E IN
TO THE PU • DATSPECTR'
OS■IGNATUR[
SIGNED THI DAY F 1
OWNER OR NEW HOUSE SWER
OM W NEAO[NT EECONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
/LTTIC TANK,SEEP,PIT(f)
1
HERESY TATE ACKNOWLEDGE IE I:a I HAVE READ THIS APPLICATION ATID/OR DRAI NFI ELO
AND STAT[ THAT 7N[ A6OV[ IS CORRECT AND AOR[.[ TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SIrW RS. CESSPOOL ❑ DRYWELL ❑
I HKR[BY C[ IPY THAT 1 AM PRopKi-LY REGISTERm AND/OR ALTER,REPAIR.S[WR OR
LI C[N■tD AS UIRED eY LOS ANGLES C UHTY AND STAT[ OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA O AT I AM TH[ LEGAL OW OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, TH SO D[SCRIB[D R[SID I RTY. ABANDON HOUSE/EWER
SIGNATURE ❑
OF PER MTTTQ A SACKFILL SErU TANKA
SEEP.PIT(/) �J CEYtOOL.S
VALIDATION JACK R. ALLEN
WL. Y.O.
SUPERVISING MECHANICAL I NGINE(SR
H