HomeMy Public PortalAbout10742 GRAND AVE_Sewer__ Am�1v r OF COUNTY ENci-INEM SEWER—SEWAGE DISPOSAL 3 4171
ION OF BUILDING AND SAFETY PERMIT APPLICATION
OOUNTY OF IAS ANGEY
WILLIAM J. FOX, COUNTY EHOIIN[[R BUILDING q /�
ADDRESS _,4
FOR
FOR APPLI TO FILL IN LOOAUTY -
BUILDINGYEARM
A D D R ES6 CJIIOES ST. 47.JV L -
LOCALITY DIVR10T N0. SERIAL N0. -PERMIT 110.
NEAREST - A 3�7 SS-t_
cRosa$T. 4 r
REOEIVED BY Ready far Iaap"dom DATE ISSUKO
OWNER ,
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MAIL USE ONE OCCUPANCY R YAP
ADDRESS
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CITY TEL-1110. { ^ Q
CONTRACTOR f'Al l f o=j a SewerrrOa�� n Co.IMP.NO. 8f
ADDRESS 1.il 7 Cnl egrnVe—�V@.
CITY MontphFilln TELNOjNjon TRUNK MIT N0.
A E
REGISTRATION NO. NTY ROAD FERMI
LEGAL O STATE ENOROA NT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRAOT INDUSTRIAL
jl N0.O BLOM WASTE APPROVAL
412E OF LOT C' NOW ON LOT ARGEE
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER ! i a." RECEIPT NO. DATE BY
HOUSE SEW CON G To
PRIVATE DISPOSAL SYSTEM 1.00
CONN ECt AD 1 IONAL BLDG.6A 911IEPTION RECORDE
WORK TO HOUSE SEWER 1.04
A LT E G AI I M N G DATE Y
SEWER OR DISPOSAL SYSTEM I_"
D18CONNECT AND ABANDON SEWER
AND/OR DISPOSAL BYSTEM 1.00 CONNECTION DATA
PITS AND/OR DRAINFIELD 2.0e STATION Q DEPTH
CESSPOOL--b"ELL
GPECIAL CONDITIONS ONLY. Loi NHO REFERENCE
LOW
TYPE OF CONNECTION ENGTH FROMr,/
OWNERS PERMIT ; 1 00 Y. CURB P.L. Y.L TO P.L (/
AUTHORIZATION TOTAL FSE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIR NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING, APPROVALS INSPECTOR'S SIGNATUREATE
DWELLING TO THE P IC SEWER
SIGNED THIS DAY OF'
NEW HOUSE SEWER f f'
OWNER 0@ CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
/} y _ ! ifiPT10 TANK]BEEP.PIT($)
ADDRESS/—s AND/OR DFIA NFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL E] DRYWELL�
CATION AND STATE THAT THE ABOVE I$CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEINER OR
REGULATING PLUMBING AND SEWERS. SEWAUE DISPO"L SYSTEM
1 HEREBY OERTIFY THAT I AN PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE BE-WEB
STATE OF CALIFORNIA.0 T AT I AN THE LEGAL OWN-
ER OF THE A13OVE DESCRI D R IDENTIAL PROPERTY. 13AOKFILL SEPTICTANK
SIGNATSEEP.PIT(S)❑ OE88POOLY�
URE
OF PERYITTE
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