HomeMy Public PortalAbout10656 KEY WEST ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEINER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
CO,:-. TY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING / Z
I ADDRESS
FOR APPLICANT TO FILL IN LOCALITYBUILDING - NEAREST
ADDRESS OA CROSS ST.
1 56 Kew t�e� , St: pot �-
LOCALITY memale p i DISTRICT NO. SERIAL NO. PERMIT NO. c
NEARESTROSST. E1 Monte AVe• S A X 95 2st-�d7S
{ RECEIVED D¢Y Ready for Inspection DATE/ISSUED
OWNER P. L. MON12tt �
Jj�A(�lt7t � 'A£j S
MAIL
ADDRESS 2.'721 San Gahri Al Blvd , USE ZONE OCCUPANCY BK MAP PO
alrySan Gabrie3TEL N0 At. 94364 A - 1
CONTRACTOR L.D. & Me Const. Co. CSO, �� �� -a
ADDRESS 21 Wisteria JAVA. JOB.NO. 5
CITY Arcadia TEL-NO. Do 62238 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 - C 42 COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 107 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT 2 CHARES
USE OF
BUILDINGS Res.• & Garage CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I D E I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RCORDED
WORK TO HOUSE SEWER 1.00 NO. I DAT 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 I STATION *��,p DEPTH 6
CESSPOOLDRYWELL
SPECIAL CONDITIONS ONLY 2.00 ' M NHOLE REFERENCE
UPPER run=
TYPE OF CONNE TION `,__LENGTH FROM /
OWNERS PERMIT $ 1 00 04#108 P.L. M.L.TO P.L. 0
AUTHORIZATION TOTAL FEE 4150
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THIS - DAY OF -- - 19.._- G �'
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT-------------------------------.........--...............................
- BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS--------------•-----------•---..........-......-....I.................................. AND/OR DRAINFIELD
1 HEREBY-ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[3 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 REPAIR.
DISPOSEWER R
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE 7 n� /� } n SEEP.PIT(S)o CESSPOOLS❑
OF PERMTTEE---- -..1J.1.�! ..JYll....SLQ .V�-----�tQ.R--------
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