HomeMy Public PortalAbout10626 KEY WEST ST_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 Q
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 10626 Key West St. CROSSST.
DISTRICT N0. SERIAL N0. PERMIT NO.
LOCALITY Temple City c
NEAREST A /qSj
CROSS ST. El Monte Ave• •�-+�//S
RECEIVED BY Reedy for Inspection DATE ISSUED
OWNER P.L. McNuttMAIL
ADDRESS,,72:k 88n Gabriel Blvd, USE ZONE OCCUPANCY BK MAP PG
CITY San Gabriel TEL-NO. At. 94364 -
CONTRACTOR L.D. & M. Const. Coy /� /� �[y►� t/
ADDRESS 21 WiRteriaAyr3. JOB.NO. 91' CLL_ 7 T
CITY AReadia TEL.No. DO 62238 TRUNK PERMIT NO.
STATE
REGISTRATION NO. ZZ 3613 C 42 COUNTY ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. lit PERMIT NO.
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. BARGES
NOW ON LOT
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF W K FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 RECEIPT N0. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTIa RECORDED
-WORK TO HOUSE SEWER 1.00 NO
ALTER OR REPAIR EXISTING TE 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/ORDRAINFIELD 2.00 STATION DEPTH (p
CESSPOOL—DRYWELL /0� ��� MANHOLE REFERENCE w
SPECIAL CONDITIONS ONLY 2.00
I '
TYPE OF CONNECTION �,� LENGTH FROM 3D
OWNERS PERMIT $ I 1 00 lY-- CtMB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE I 50
CONTRACTOTHIS
R TO CONNECT CONTRACTED
E ABOVE D SCRIGEDHEREIN
EXISTING ED APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-------------------DAY OF--------_.----._-------.------.19...-... NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT...........-......-......-....-----_..-----....._.....---•--
- BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS........................................... -- ..........•...----- ................-... AND/OR DRAINFIELD
1•HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL I] DRYWELL 0
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL_SYSTEM
1 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
T SEEP.PIT(S)E3 CESSPOOLS
OF PERMRITTEE..-1J►Ds.---BC-- -.-----C.Cl$ L i -•-4+k3� - ••---
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