HomeMy Public PortalAbout5646 GRACEWOOD AVE_Sewer__ DEPAIVrIAENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
03UILDING !- }
[ADDRESS (�( =t CD /u /_.Z.V CROSS ST. 1•l�t ' "r
`LOCALITYFS DISTRICT NO. SERIAL NO. PERMIT NO.
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NEAREST ♦ ._..._- A I C,; ' S
CROSS ST , /1 �� �± 11
REQEIVED,BY Ready for Inspection DATE ISSUED
OWNER
MAIL /�)) s USE ZONE OCCUPANCY MAP
-ADDRESS /<LUt/j/tT
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CITY TEL.NO. ,-, --
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CONTRACTC@Slifornla Sewer Const.CO. co.!MP.No. f� 9 �'
ADDRESS 1317 Colegrove Ave.
-- JOB N0.
CITYMontebello TEL.%Wion 1-5648 TRUNK PERMIT NO.
STATE
REGISTRATION N104448 Sta&COUNTY
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
L/ t/' C� PERMIT NO.
BLOCK TRACT INDUSTRIAL
SIZE OF LOT "f d X //� NO.BF BL WASTE APPROVAL
/ ! NOW ON LOT
CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
N0. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I f DATE BY
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- DATE
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 2.00 STATIONsd,Z 7�' <.° DEPTH (p
CESSPOOL—DRYWELL ti
SPECIAL CONDITIONS ONLY 2.00 / MANHOLE REFERENCE
UPPER
TYPE OF CONNE TIW --,, LENGTH FROM
OWNERS PERMIT $ 1 00 M+" 1 P.V M.L.TO P.L.
AUTHORIZATION f TOTAL. FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER�c� .} Q
SIGNED THIS-.,g- 7h/-D Y OF. .tJ�d�xfl4sf-.
._ 1Q�� NEW HOUSE SEWER --
OWNER OR • CONNECT ADDITIONAL
OWNERS A�/;EN — ............. ....... .... BUILDING OR WORK
C TANK SEEP.
ADDRESSS-b-�---- ....................-•-------- EP/OR DRAINF ELD PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL(] DRYWELL E]GATION 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 DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 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 ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)E] CESSPOOLS
OF PERM ITTEE-.._._-. _ . a—0, , 2 I
76A642D 663 1/53