HomeMy Public PortalAbout10727 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 I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 10727
Graced Avp7e CROSS ST.
LOCALITY Li'l Mont® DISTRICT NO. SERIAL NO. PERMIT NO.
NEARESTS
•
CROSS ST. El Monte Ave
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P. L. McNutt
MAIL
ADDRESS 2722 San Gabriel Blvd* USE ZONE OCCUPANCY I BK MAP PG
CITY S$$ Gabriel TEL.NO. AT 94364
CONTRACTOR L.D. k M CONSTRUCTION CO.
Co.imp.NO.
ADDRESS 408 Winthrop Dr• JOB NO.
CITY Alhambra TEL.NO. AT 48315
TRUNK PERMIT N0.
STATE
REGISTRATION NO. 113613 C 42 COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 59 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS
NOW ON LOT 1 CHARGES
USE OF
BUILDINGS 1 Res- CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
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 9R REPAIR EXISTING NO- I 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/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURB P.L. M.L.TO P.C.
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
1
I SIGNED THIS--------------------DAY OF................................._.._19....... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_____________________.-___--__________-.---------------------------------- BUILDING OR WORK
ADDRESS-..................... SEPTIC TANK.SEEP.PIT(S)
- - _.....-... -... ..__...._.. - AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] 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 THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)Ej CESSPOOLS❑El I
�1 ; /i/ �
OF PERMITTEE._yl_
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