HomeMy Public PortalAbout10702 LA ROSA DR_Sewer__ DEPARTMENT OF COUNTY- ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
2
WILLIAM J. FOX. COUNTY ENGINEER ADDRESBUILDINS 14 G 7/� /
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FOR APPLICANT TO FILL IN LOCALITYBUILDI NG
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ADDRESS NEAREST
10702 Ila Rolla St GROSS ST. /'�(ryr �r L _
LOCALITY El Monte DIISST�RI/CT�NO. SERIAL NO. PERMIT NO.
NEAREST Bl Monte Ave. `� A � !/3 �� '�"S' 5 ' 5r
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P.L. MnNutt `�j -e — - -- //'- /'✓ 3
MAIL 1
ADDRESS 'l•7Zj San Gabriel Blvd, USE ZONE OCCUPANCY MAP
BK PG
crcvSan Gabriel TEL."D. At 94364 �•f' a - -
CONTRACTORL.D. & M. CONSTRUCTION CO. CO.IMP.NO.
ADDRESS 408 Winthrop Dr. JOB NO.
CITY Alhambra TEL.NO. At 48315 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 C 42 Ff COUNTY ROAD PERMIT NO.
LEGAL \
DESCRIPTION LOT N0. 54 STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT 17867
INDUSTRIAL � �\
N0.OF BLDGS. WASTE APPROVAL
SIZE OF LOT NOW ON LOT 1 ,CHARGES
USE OF J \
BUILDINGS I Rea, CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PU BLIC SEWER (P $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 �✓
CONNECT ADDITIONAL BLDG.OREXCEPTION RECORDED
WORK TOHOUSE SEWER 1.00 -
ALTEReR REPAIR EXISTING NO. I'DATE IBY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR ��77
PITS AND/OR DRAINFIELD 2.00 STATION �' DEPTH
CESSPOOL—DRYWELL _
SPECIAL CONDITIONS ONLY 2.00 Q MANHOLE REFERENCE
n L UPPER _LDWER
_TYPE OF CONNECTION LENGTH.F.ROM—
OWNERS PERMIT
$
I 00 'Y CURB P.L. M:L:TO P.L.-----
AUTHORIZATION TOTAL FEE
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 w
SIGNED THIS..............._...DAY OF................................_._._.. 19_._... NEW HOUSE SEWER �.J I,. Yr 5
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT................................................................ _ BUILDING OR WORK
ADDRESS......................._. SEPTIC TANK.SEEP.PIT(S)
........_.....__........_............_.................._..__. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL 0 DRYWELL Ej
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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED —
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
Q S
f SEEP.PIT(S) CESSPOOL
SIGNATURE
OF P ERMI TTEEJ�d _......_.... .._._. ---- _^.."' "�..-'S.:------
7GA642D 663 1/53