HomeMy Public PortalAbout10660 KEY WEST ST_Sewer__ DEPARTMENT OF COM-= ENGINMER SEVER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
Co�;=�-1N
'OF LOS AGELES / //
WILL J? FCX, COUNTY ENG610
INEER I BUILDING
ADDRESS /� In
FOR APPLICANT TO FILL IN LOCALITY A
BUILDING ADDRESS 10660 NEAREST �
gA� �eb''t �f:� CROSS ST. (
DISTRICT N0. SERIAL N0. PERMIT NO.
LOCALITY Temple City
c
NEAREST 'J_ A ������/y� S
CROSS ST. EZ Monte AVe•
RECEIVED BY- Ready for Inspection DATE ISSUED
OWNER P.L.. McNutt dL - (O -S3
MAIL
ADDRESS 272-- Ban Gabriel Rm,vA , USE ZONE OCCUPANCY BK MAP PG
CITYSan Gab_Y'iP1TEL.NO. AtdF,
9 � A
CONTRACTOR - La D. & M. Const, CO• g) No. Q
ADDRESS 21, Wisteria AVe. JOB.NO. l
CITY Aroadia TEL-.NO. La 622 $ TRUNK PERMIT NO.
STATE
REGISTRATION N0. 11,161,r3 - (!ap R:COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 10STATE ENCROACHMENT
6 PERMIT NO. f
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL I
SIZE OF LOT N0.OF BLDGB. CHARGES
NOW ON LOT 2
USE OF
BUILDINGS Res• & Garage. CONNECTION CHARGE FEE 1
NO. DESCRIPTION OF WORK FEE /
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER 0 $ 3.50 0 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 DIE 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 L STATION 6 f��,S DEPTH
CESSPOOL-DRYWELL Ir
SPECIAL CONDITIONS ONLY 2.00 - 1 ( /� IV►ANHOLE REFERENCE
- _ I J Q-�/ U P P E R LIKEbR
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT s 1 Q0 same P.L. v M.L.TO P.L. r 3o
AUTHORIZATION I TOTAL FEE 1 4 b0
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...........______......-.......... 19_...... , NEW HOUSE SEWER 7
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_-------_-----------------_----------- ------- -BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS. - - - - - AHD/OR DRAINFIELD
I 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 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 Ej
SIGNATURE L.D. & Id. r'
�y SEEP.PIT(S)� CESSPOOLS E3
Const. Co.
OFPERMITTEE----•-------..........-.............__•_--------------..............__._..
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