HomeMy Public PortalAbout10703 GRAND AVE_Sewer__ DEPAW MENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDINGNEAREST
ADDRESS 10703 Grand Avenue CROSS ST. �^
LOCALITY El MOnte DISTRICT NO. SERIAL NO. PERMIT NO.
NEARESTA S
CROSS ST.
E1 MnntA Avg
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER pa L. McNutt
MAIL
ADDRESS 272- - San Gabriel Blvd. USE ZONE OCCUPANCY MAP
BK PG
CITY a brial TEL.NO. AT 94364
CONTRACTORL.D. do M, Construction CO.
CO.IMP.NO.
ADDRESS 408 Winthrop Dr. IDB NO. L 1"
CITY Alhambra TEL.NO. AT 48315 TRUNK PERMIT NO. ---
STATE
REGISTRATION NO. 113613' — C-42 COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. = STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17667 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS l CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ S 3.50 RECEIPT NO. ( 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. I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
. AND/OR DISPOSAL SYSTEM 1.00CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL -
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
LOWER
TYPE OF CONNECTION 'LENGTH FROM
Y. CURB P.L.' M.L.TO-111.t.-
,
OWNERS PERMIT ; I 00
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................................__.__19___-._ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT........................... ...................................._........ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS - - AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL F]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 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 THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS Ej
IGNATURE / � //, `,� '` SEEP.PIT(S)[] CESSPOOLS❑
SOF PERM IITTEE.:-������ T__� ......
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