HomeMy Public PortalAbout10733 GRAND AVE_Sewer__ DEPARTMENT 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
BUILDING NEAREST
ADDRESS 10733 Grand Avenue CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
$1 mit® A S
NEAREST
CROSS ST. 31 Monte Ave•
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER R- Td- MgNUtt
MAIL
ADDRESS 2721 San Gabriel Blvd. USE ZONE OCCUPANCY BK MAP PG
CITY San Gabriel AT
CONTRACTORL•D•& M. 0=SjLTRIICTT0N CO.
CO.IMP.NO.
ADDRESS 408 I Winthrop Dr. JOB N0. %
CITYAlhagbrs TEL'ND- AT 48.315
TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 C 42 HICOUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NOA0 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT 2 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. I 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 I 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 ; i 00 Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
1 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/ RAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] 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 DISPOSAL SYSTEM
I HEREBY CERTIFY THAT IAM 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
SIGNATURE SEEP.PIT(S)E] CESSPOOLS I]
OFPERMITTEE.............---..................-..........-...----------------------------
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