HomeMy Public PortalAbout10644 KEY WEST ST_Sewer__ DEPARTMENT,OF COUNTY ENGINEER SEWER=SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
CbUNT%'OF LOS ANGET S
WILLIAM J. FOX, COUNTY ENGINEER oI BUILDING
ADDRESS
- FOR APPLICANT TO FILL IN LOCALITY �¢-�-�—�I2,�r �•c. � _
BUILDING NEAREST
ADDRESS 10644 $183Z West St CROSS ST. T /J
LOCALITY TAmple City DISTRICT NO. A SERIAL NO. �j PERMIT NO.
NEAREST A
CROSS ST. El Monte AV e•
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P.L. VoNL7tat
MAIL
_ADDRESS 272j 38n Gabriel Sled• USE ZONE OCCUPANCY BK PQ y
CITY San Gabriel TELAO. —At-0 94364 A — /
CONTRACTOR L.D. & M"e Const• CO• O. V /y� -3 44
ADDRESS 21 Wisteria live: JOB.NO.
CITY ARe dia TEL.NO. Do62236 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 11.17)f,]21; — (r�Q � COUNTY ROAD PERMIT N0.
f LEGAL STATE ENCROACHMENT \
LOT NO. 10.9 PERMIT NO.
DESCRIPTION
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF SLOGS. �
NOW ON LOT 2 CHARGES
USE OF
& Garage
BUILDDINGS R@s• CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $ 3.50 3 O 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 N0. I D TE I BY
ALTER OR REPAIR EXISTING
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 O DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / / MANHHOLLtbm$fiERREFERENCE E' " LOWER
tTYPE OFCONNECTIONLENGTH FROM ,
-Y. -61iR8 P.L. `-M.L.TO P.L.
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE 4 10
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGAPPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS--------------------DAY OF...................__..._..........._19..._... NEW HOUSE SEWER
CONNECT ADDITIONAL. .
OWNER OR BUILDING OR WORK
OWNERS AGENT----•--------------------•------------
- - SEPTIC TANK,SEEP.PIT(S)
ADDRESS.................-------•-------•-----------------•---............... - ---------- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ.THIS APPLI- , CESSPOOL E] DRYWELL 11
CATIONAND 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
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND
ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)Ei CESSPOOLS O
• SIGNATURE
OF PERM I TT E E
76A642D 663 1/53