HomeMy Public PortalAbout10632 KEY WEST ST_Sewer__ DEPARMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
CCIINTY,OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENIBINEER BUILDING
ADDRESS Q CO�
y
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 106.12 Vey Wesi CROSS ST.
LOCALITY Temlile p f .r DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST S. A ��5�-� ���D`c
�
cRoss sT. E1 Monte AQe• E/CCEEIVED BY Roady for Inepeation DATEISSUED a
OWNER R.L. MONUttMAIL
ADDRESS 272-1 San Gabri.`el Blvd• USE ZONE - OCCUPANCY 'MAP
BK PG
CITY San Gabriel TEL.NO. At 94364 A
CONTRACTOR yoDo & M. Consts, CO. C ,NO, AnI,
ADDRESS 21 Wisteria Ave, JOB.NO.
CITYAY,Qaalia TEL-NO. Do 62238 TRUNK PERMIT NO.
[STATE
REGISTRATION N0. 113613 C-42 LJ COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT \
DESCRIPTION LOT N0. 1 n PERMIT NO.
BLOCK TRACT 19189 INDUSTRIAL
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 @ $ 3.50 5O RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION�RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO I ATE 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 STATION 3'f d DEPTH C�
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / 3,6-�.� MANHOLE REFERENCE R
TYPE OF CONNECTIONL1 LENGTH FROM i
OWNERS PERMIT $ 1 00 P.L. M.L.TO P.L. 30
AUTHORIZATION TOTAL FEE 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 vG CiK .2' —
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
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND
DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED. BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
T�
SI .OG 9_ M. CQjZs--• V/�O. SEEP.PIT(S)E]- CESSPOOLS I]
GNATURE �.JJ
OF PERMITTEE-----------—---------_...-------••---------•--••-----•------.....-•--------
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