HomeMy Public PortalAbout10709 LA ROSA DR_Sewer__ DEPAISrMENT OF COUNTY ENGINEER .SEWER=SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
'c COUNTY OF LOS ANGELES -
WILLIAM J. FOX. COUNTY ENGINEER BUILDING 14 e5
.ADDRESS GJ
FOR APPLICANT TO FILL IN LDcnurY `/ ^v Aft-
BUILDING
ADDRE S 10709 1a RoBa St. CCROSSST.
LOCALITY El Monte DISTRICT NO.
NO. SERIAL NO. PERMIT NO.
NEAREST El Monte Ave. .� r=0 A � yZI� --�'S35 '�t✓S
GROSS ST.
RECEIVED, B�V Ready for Inaoecti0n DATE ISSUED
OWNER PDL• MoNu t t �l+[/ .9/,/7s
ADDRESS ?"7"id �'n Gabriel Blvd. U$E ZONE OCCUPANCY MAP
BK PG
CITY San GabrleFELND- AT 94364
CONTRACTOR I,
'a
M_ CON9TRTTCTTON OO CO.IMP.N0.
.ADDRESS flog Winthrop Dr. JOB NO. d/Ish
CITY Alhambra TEL.NO.- AT 483155 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613. G 42 COUNTY. ROAD PERMIT NO.
LEGAL J
DESCRIPTION LOT N0. 44 STATE ENCROACHMENT /}�\
PERMIT N0.
.BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT `� ,,CHARGES
USE OF
BUILDINGS 1 CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE ;, \
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLIC SEWER 0 $ 3.50 RECEIPT NO. IDATE---",,,I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING - NO. I DATE I 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 GRAINFIELD 2.00 ..STATION 3fg2 DEPTH 5�0 �
CESSPOOL—DRYWELL 1
SPECIAL CONDITIONS.ONLY 2.00 J/� p MANHOLE REFERENCE
.4- UPPER aDWER,
_ TYPE OF CONNECTION LENGTH.F.ROM
OWNERS PERMIT 1 00 "Y. CURB P.L. M'L:TO.P..L.
AUTHORIZATION TOTAL FEE
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
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT-----------_---------------.._--------------------------------------_.._.__ BUILDING OR WORK
ADDRESS—---....._.._......_..--.._. SEPTIC TANK,SEEP.PIT(S)
....._........__.__.._._.._.._......_....._..._. AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ..THIS APPLI- CESSPOOL I] 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
AND/OB LICENSED AS REQUIRED 13Y 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 RESJDD/EENNTTIAL PROPERTY.. - BACKFILL SEPTIC TANKS
SOF NATUREPERMITTEE..� _._..._........w/.rK SE EP.PIT(S)� CESSPOOLS
7GA643D 663 1/53 .