HomeMy Public PortalAbout10666 KEY WEST ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER . SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY' PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGB U I L D I N GINEER ADDRESS /Q
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 10666 Vey WARt St;. CROSS ST.
LOCALITY 'I'eml'a CitDISTRICT NO. SERIAL NO. PERMIT NO.
y
NEAREST A
CROSS ST. �9���El TvTnn'I;9 Ay A i RECEIVED.BY Ready for Inspection "DATE ISSUED
OWNER P.T-a MC,NuttMAIL
ADDRESS 2 7�a San Gabripl blvd: USE ZONE I OCCUPANCY BK MAP PG
CITY San Gabriel TEL.NO.At. 94Z64
CONTRACTOR L.D. & M. Const: Coo Aq=m1prN0. e
ADDRESS 21 Wisteria Ave. JOB.NO.
CITY Arcadia TEL-NO. Do 62238 TRUNK PERMIT NO.STATE
C
REGISTRATION NO. — C 42 COUNTY
ROAD PERMIT NO.
DESCRIPTION LOT NO. 105 STATE ENCROACHMENT
PERMIT NO. f
BLOCK TRACT 19189INDUSTRIAL
WASTE APPROVAL /
SIZE OF LOT N0.OFOBLD
G8.
NOW N LOT
2 CHARGES
—BUILDINGS DINGS RB$• & Gara a OF CONNECTION CHARGE FEE \
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE '
HOUSE SEWER CONNECTING TO
_ PUBLIC SEWER $ 3.50 RECEIPT NO. I DATE/ I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTIONIRECORDED
— WORK TO.HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO DATE ( 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 '7," 'j,3, DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 /L C MANHOLE REFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM
O'N'RB P.L.4� M.L.TO P.L.
OWNERS PERMIT � I I 00
AUTHORIZATION I TOTAL FEE 4. 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 s; C rk c
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT._...-.....__...---. BUILDING OR WORK
- - - - - -
SEPTIC TANK,SEEP.PIT(S)
ADDRESS...............................................- -•----.......................... AND/OR DRAINFIELD ,
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL I] DRYWELL
CATION .CND 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/OWLICENSED 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
SEEP.PIT(8)[] CESSPOOLS
OF PERMITTEE- -------.---
76A642D 663 1/53 Ja