HomeMy Public PortalAbout10708 LA ROSA DR_Sewer__ DEPATi'PAMNT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
± WILLIAM J. FOX, COUNTY ENGINEER I ADDREBUILDING
SS / {
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 10708 I.R Rn Pa St. CROSS ST.
LOCALITY El Monte DISTRICT
7NO. /S/SERIAL NO. 7 PERMIT NO..
NEAREST
CROSS ST. El Monte Ave. • ' `� A '- �J - ���" S
RECEIVED BY Ready lar lmealian DATE ISSUED
OWNER P T. MRNutt
MAIL 1
ADDRESS 2+722- San Gabriel Blvd. USPZONE OCCUPANCY BK MAP PG
CITY San GabrielTEL.NO• AT 94364 �1Fs
CONTRACTOR L.D. & M. CONSTRUCTION CO• -- �-�`
_ CO.IMP.N0. —
ADDRESS 406 .Winthrop Dr.
JOB N0.
CITY Alhambra TELRO, AT 48315
TRUNK PERMIT N0,
STATE
REGISTRATION NO. 113613 0 42 COUNTY
ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. FJ3 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17861 INDUSTRIAL /
512E OF LOT N0.OF BLOCS. WASTE APPROVAL
NOW ON LOT p_ CHARGES
USE OF
BUILDINGS 1 Rea, CONNECTIONCHARGEFEE _
NO. DESCRIPTION OF WORK FEE J'
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE \�
1 PU BLICSEWER @ $ 3.50 RECEIPT NO. DATE BY
H OUSE SEW ER CON NECTING TO I �/I
PRIVATE DISPOSAL SYSTEM #2.00
CONNECT ADDITIONAL BLDG.OREXCEPTION RECORDED
WORK TO HOUSE SEWER NO.iALTER OR REPAIR EXISTING GATE BY
SEWER OR DISPOSAL SYSTEM DISCONNECT AND ABANDON SEWERANO/Ofl DISPOSAL SYSTEM CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR GRAINFIELD STATION �7"/� DEPTH i��CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY i/ L�. MANHOLE REFERENCE
'J T T.AUPPER —LOWER
p/ LEN-G
PERMIT 7
CONNECTION
d�iO "
OWNERS 00 CURP.L. ML
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING—
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE GATE
/a
SIGNED THIS..._._..._-------DAY OF..........__............._...._.._19_.__ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS •AGENT......._.._......_.._.._..........___.........__..............__..._.._ BUILDING OR WORK
ADDRESS........................................_.._.._.............._.........._.._.._..._. SEPTIC TANK.SEEP.PITS)
AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL I] DRYWELL E]
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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN, ABANDON HOUSE SEWER
OF THE ABOVE DESCRIBED
REBID. ERTSEPTIC ❑
SI D
SIGNATURE SEEP.PIT(S)ECESSPOOLSO
OF PERMITTEE...
76AG42D 663 1/53