HomeMy Public PortalAbout10616 KEY WEST ST_Sewer__ DEPARTMENV OF COUNTY ENGINMM J SEWER—SEWAGE DISPOSAL �
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
'LEI
NTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER i) BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY G
BUILDINGNEAREST !�
ADDRESS 10616 Key Rest Ste CROSS ST. \J
LOCALITYTAmy�T e�� 4 DISTRICT NO. SERIAL NO. �J PERMIT NO. ,C
NEAREST �`i t) A �7 S�-�"//J� `�
CROSS ST L'i 1 Ljon t A AvA. RECEIVED BY Ready for Inspection DATE ISSUED
OWNER p"T." jCXlIt+ �- � /(p `.13
MAIL t USE ZONE OCCUPANCY MAP
ADDRESS 27 ,:• 'Rai1 Glabriel BiirG�a I BK PG
CITY San Gabfiel TEL.NQ. At 94364 A -
CONTRACTOR L.D• & M. Coriat. Cezu*8PNO. �_4C -!,GSL
ADDRESS 21 Wisteria Ave. r� JOB.NO 45-6—
//
CITY Arcadia TEL.NO. Do62238
TRUNK PERMIT N0.STATE
REGISTRATION NO ',71 fjI:'� (� 4
2 COUNTY
ROAD PERMIT NO
LEGAL DESCRIPTION LOT NO. 113 STATE ENCROACHMENT /
PERMIT NO 1
BLOCK TRACT 19189 WASTE APPROVAL \
SIZE OF LOT NO OF BLDGS. CHARGES
NOW ON LOT 2
USE OF
BUILDINGS Res. & Grage CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO3 50
PUBLIC SEWER @ $ 350 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG.OR EXCEPTION REFORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO I DAT 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 -(- /3, 5 DEPTH ('
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 / '� MANH�OOL�EREFERENCE RLOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I 1 00 P L V ML TOP L
AUTHORIZATION TOTAL FEE 4 50
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 .9 `7
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT----- - _- - BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS _ - _- ----____- --.-_ _- AND/OR DRAINFIELD
1 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
RECULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
i 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 I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE L*D* & M. Const. 00 SEEP PIT(S)[] CESSPOOLS
OF PERMITTEE - - -= - - - - - - -
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