HomeMy Public PortalAbout10714 LA ROSA DR_Sewer__ DEPAWYMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES,
WILLIAM J. FOX, COUNTY ENGINEER BDDUILDI
RESS
A
FOR APPLICANT TO FILL IN LOCALITY
'BUILDING
ADDRESS 10714. La Rosa St. CNROSSST. - � �_A/�c_ .
LOCALITY El Monte - DISTRICT N0. SERIAL NO. PERMIT NO.
NEAREST N.I.—MonteAve* A6 / ...J ,j,3.3 — S
CROSS ST.
RECEIVED BY Ready Iar IaeaecRan DATE ISSUED
OWNER PoL• McNuttMAIL
ADDRESS 2722 San Gabriel Blvd. USeZONE OCCUPANCY BR MAP PG
CITY San GabrielTELNO• AT 94364
CONTRACTORL.U� BH_ C0ISSTRIICTI0A CO. CO. NO.
ADDRESS 408 Winthrop Dr. JOB NO.
CITY Alhambra TEL.NO. AT 48315 TRUNK PERMIT NO.
5 STATE
REGISTRATION NO. I I Sri 3 O 4,7 ❑ COUNTY .ROAD PERMIT NO. �/ �.
LEGAL 52 STATE ENCROACHMENT " \
DESCRIPTION LOT N0. PERMIT NO. s
BLOCK TRACT 17867 INDUSTRIAL'
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT 1 X CHARGES X'
USE OF
. BUILDINGS 1 Res. CONNECTIONCXARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE / \
1 PUBLIC SEWER 05 $ 3.50 ,RECEIPT NO. /I� \DA E I BY \\
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDO.OR / EXCEPTION REBORDED
WORK TO.HOUSE SEW ER 1.00.
ALTER ORREPAIREXISTINGN0. DATE BY
SEWER OR DISPOSAL SYSTEM LOO � I \�I
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS ANDIOR]GRAINFIELD 200 STATION TL 3� DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 A MANHOLE 4—UPPER —LOWER,LOWER'
T,YPE'OF CONNECTION `i LENGTH.F.ROM
PERMIT $ 1 00 -Y! cues P.L. M1:TO P.L.
OWNERS
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING '.
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS------.._--------.DAY OF....___..---------------------_ 19------ NEW HOUSE SEWER �U S`�{�/3✓�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT................................_.._.._......................... .BUILDING ORWORK
ADDRESS—.._..............__..5.._...........--...: SEPTIC TANK,SEEP.PIT(S)
_.._......._..__........_._..._.-- AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVEREADTHIS APPLI CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE ISCORRECT 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/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 RE IAL PROPERTY. BACKFILL SEPTIC CESSPOOLS
SIGNATURE ®,/{,'�y� L1/% SEEP.PIT(S)Q CESSPOOLS
OF PERMITTEE: .. ._..- ___...
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