HomeMy Public PortalAbout10622 KEY WEST ST_Sewer__ DEPARTMEaVT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
C(ATNTY-CIF LOS ANGELES -
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS /(J
-FOR APPLICANT TO FILL IN LOCALITY
BUILDING I CLEAREST
ADDRESS 10622 Key -West', S`ti CROSS ST.
LOCALITY
NEAREST Temiple 'Olt yy DISTRICT NO. SERIAL NO. PERMI-NO.
CROSSST. El Monte 'Ave: 5 A S
RECEIVED BY Ready for Inspeotlon, /� DATE//ISSUED
OWNER POTI_RR 111-itt (gIJ. /L
ADDRMAILESS 2 72E San Gabriel- Blvd• USE ZONE OCCUPANCY MAP
BK PO
CITY San GabrielTEL•N0•ll.t. 94364 – l �( �7
CONTRACTOR T., T). Rc � (InTlb`t (t10,
ADDRESS 21 Wisteria Ave• JOB.NO.
CITY Arcadia TEL.NO. Do 62238 TRUNK PERMIT NO.
113613 042
STATE \
REGISTRATION NO. COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION_ LOT NO. 12 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 19189 WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT 2 CHARGES
USE OF
BUILDINGS Res• & Garage CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE \
HOUSE SEWER CONNECTING TO
PUBLICSEWER ,6 $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION R CORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DA I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.001 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 I STATION -�_4-to p d DEPTH �O
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I / MANHOLE REFERENCE r �,/
uiwm i C U/_ LOWER
TYPE OF CONNECTION a . LENGTH FR M /
OWNERS ; I 00 CtH+B P.L. M.L.TO P.L.
_PERMIT I •
AUTHORIZATION I TOTAL FEE 50
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING I'D THE PUBLIC SEWER
SIGNED THIS-------------------DAY OF.........•.....-.............-........19........ NEW HOUSE SEWER Sc`Y0
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT--------------------------------------------------------------------------
BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS........................................................................................... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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 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
GNATUETT� D � �t n SEEP.PIT(S)E] CESSPOOLS I]
OF PERMRTTEE------- /a 1----.W.__Kit ..__-frA..a_----..
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