HomeMy Public PortalAbout10650 KEY WEST ST_Sewer__ DEPARTMENT OF COUNTY,ENGINEER I SEWER•=SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
CGUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENDINEER I BUILDING /� / �� �✓'
ADDRESS
FOR APPLICANT TO FILL IN LOCALITYBUILDING
O6 O JCA W NEAREST
ADDRESS 1
b � Q+g is .Si:: CROSS ST. '
LOCALITY DISTRICT NO. SERIAL NO.- PERMIT NO.
NEARESTnCtn A
CROSS ST. El Monte Aye. RECEIVED BY Ready for Inspection hDATEISSUED
OWNER P.T.. MCiNutt /�L �G "5`-
MAIL ,
ADDRESS 272Q San rabri 1 Blvd.
I1 I USE ZONE OCCUPANCY• BMAP
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CITY San. Gabriel --TEL•ND•At. 94364 A--r GC��
CONTRACTOR L,D, 8C M• Cohat• on,
ADDRESS 21 -Listeria Lye, JOB.NO.
i
CITY Arcadia TEL.NO.At 94364 TRUNK-P_ER_MIT_NO.
STATE
REGISTRATION NO. 113613 - C42 COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT /
DESCRIPTION LOT NO. 108 PERMIT N0.
BLOCK TRACT 19189 WASTE APPROVAL
SIZE OF LOT NO.OFBLOTS. CHARGES
NOW ON LOT 2
USE OF Res.es. & Garage CONNECTION CHARGE FEE
R
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.50 31 50" RECEIPT NO. I DATE\ IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM I.00
i
CONNECT ADDITIONAL BLDG.OR EXCEPTION R�CORDED
WORK TO HOUSE SEWER 1.00 N0:
ALTER OR REPAIR EXISTING DATE ( BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATASEPTIC TANK,SEEPAE
/
_ PTS AND/OR DRAINFGELDT OR 2.00 STATION `�j A- DEPTH. (�
CESSPOOL—DRYWELL ��S
SPECIAL CONDITIONS ONLY 2.00 p�NUHOLE
PPERREFERENCE �.A
TYPE OF CONNE ION ---LENGTH FROM r
- C4R9P.L. - WL.•TO-P,:L. 30
OWNERS PERMIT $ I I 001
AUTHORIZATION TOTAL FEE 41 50 ~
I 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............--.-......-.....----- NEW HOUSE SEWER �cb GIC /7" -
OWNER OR • CONNECT ADDITIONKAL ,
OWNERS AGENT-----------------------------...........--------------------------• BUILDING OR WOR
SEPTIC TANK,SEEP.PIT(S)
ADDRESS,......i---- -- ........... --------......................................... AND/ORDRAINFIELD -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL E] DRYWELL
CA
TIONAND STATE THAT THE ABOVE 19 CORRECT PND 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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND 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 T r� . n SEEP.PIT(S)[-] CESSPOOLS I]
OF PERM ITTEE.•.---lLJ).i.-.-.SQ--X*....uun8t'*=--CO-e--•-
76A642D 663 1/53 �l