HomeMy Public PortalAbout10750 GRAND AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
No
WILLIAM J. FOX, COUNTY ENGINEER ABDDRE88
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FOR APPLICANT TO FILL IN LOCALITY T, �► L �/j//
BUILDING NEAREST
ADDRESS N CROSS ST. /041f S//Vf/�
LOCALITYT DISTRICT NO. Ready for Inspection PERMIT NO.
NEAREST
CROSS ST.
RECEIVED BY DATE ISSUED BY DATE
OWNER
MAIL USE ZONE OCCUPANCY MAP
ADDRESS AI
BK PG
IT
CITY TELAO.
CONTRACTOR California Sewer Const.CO. CO.IMP.NO.
ADDRESS 1317 Colegrove Ave.. ,Oh NO.
CITY Montebello TELAO,—--� {{�� - TRUNK RMIT N0.
REGISTRATION NO.104445 'S �'C� NTE ROAD PERMI 0.
LEGAL / „^ STATEENCROAC ENT
DESCRIPTION LOT N0. I PERMIT N0.
BLOCK TRACT L INDUSTRIAL
WASTE APPROVAL \�
SIZE OF LOT 7G' 46 N0.OF BLDGS.
NOW ON LOT C ES
USE OF r
BUILDINGS '�t CONNECTION CHARGE FE
NO. DESCRIPTION OF WORK FEE
— HOUSE SEWER CONNECTING TO D REIMBURSEMENT F
PUBLIC SEWER @ S 3.50 RECEIPT NO I DATE I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDE6
WORK TO HOUSE SEWER 1.00
— ALTER OR REPAIR EXISTING NO. I 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
CESSPOOL—DRYWELL BTATION/f`j/ DEPTH u
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
3"� W UPPER
TYPE OF CONNECTION LENGTH FROM�� 1
OWNERS PERMIT s I saw P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE
I 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__. _ _I NEW HOUSE SEWER
OWNER OR i CONNECT ADDITIONAL
OWNERS AGENT .. .. 11.� ._L'1 BUILDINO OR WORK
ADDRESS....._... ._ SEPTIC TANK,SEEP.PIT(8)
_.. _ .._._�.„..__._. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL I] 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 I AM PROPERLY REGISTERED
AZD/OR LICENSED A8 RE UIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CAL OR 0 THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE A ESC I ESIDENTIAL P 0 ERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)0 CESSPOOLS
0 PERM — -- - --- - -
I” 10
76A6421) S&E 663 4/54
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