HomeMy Public PortalAbout10715 GRAND AVE_Sewer__ DEPARTMENT 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
BUILDING NEAREST
ADDRESS 10715 grand Ayt-- )je CROSS ST.
LOCALITY El Monte DISTRICT NO. A SERIAL NO. PERMIT NO.
NEAREST /� J ' " S
CROSS ST. El Monte Ave•
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER Paha MCNnt
MAIL
ADDRESS 272-1 San Gabriel B1Yd USE ZONE OCCUPANCY I BK MAP PG
CITY San GabrielTEL.No. AT 94364
CONTRACTOR L.D. & U. CONSTRUCTION 00• CO.IMP.NO.
ADDRESS 408 31nthropDra JOB NO.
CITY Alhambra TEL.NO. AT 48315 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 C 42 COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. 57 STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT 17867INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. 1
NOW ON LOT CHARGES
USE OF 1 Res.BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
REIMBURSEMENT FEE
1 PUBLIC SEWER @ $ 3.50 RECEIPT NO. ( DATE I 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 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/ORDRAINFIELD 2.00 STATION r`•. DEPTH
CESSPOOL—D RYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT f 1 00 Y. CURB P.L. M.L,TO P.L.
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS------------------DAY OF......................................19-•-•--.. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OW N ERS AGENT-------•--------•----------------------••-•------------------------------- BUILDING OR WORK
ADDRESS-----------------------_- ----------- SEPTIC TANK,SEEP.PIT(S)
– – AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL Ej
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
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 I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDE TIAL PROPERTY. BACKFILL SEPTIC TANKS E]
SEEP.PIT(S)0 CESSPOOLS
SOF PERMRITTEE- --c'.---
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