HomeMy Public PortalAbout10715 LA ROSA DR_Sewer__ YI DEPARTAII9NT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
(. COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING ./7 /
i ADDRESS 1,071:6- �G,i'C/7.5lt_ SA
FOR APPLICANT TO FILL IN LOCALITY
AUILDING NEAREST RESS CROSS SL DY/ �/
1 10715 La�iosa�t
LOCALITY El Monte DISTRICT NO. SERIAL NO. PERMIT NO.
CNEARESTROSSST El Monte Ave. .> G0 A ll-�- 5.i3_tr lf__ S
RECEIVED BY Ready for inspection DATEISSUED
OWNER P L MrNTtttV-91
MAIL USE%ZONE OCCUPANCY I MAP
ADDRESS 272x- qan llanbri Bl Blvd. - BK PG
CITY Ran r, hrielTEL-NO- AT 94364
CONTRACTOR L.D. & M. CONSTRUCTION CO. Co.IMP.NO.
ADDRESS 408 Winthrop Dr. /
JOB NO.
CITY Alhambra, TEL.NO. AT4B315 TRUNK PERMIT NO. �i-
REGISTRATION NO113618 C 42 _ STATE
COUNTY ROAD PERMIT N0. \
LEGAL . \
DESCRIPTION LOT N0. 45 STATE ENCROACHMENT
NO.
BLOCK TRACT 17867 INDUSTRIAL
NO.OF eLDGS. WASTE.APPROVAL
SIZE OF LOT NOW ON LOT 1 CHARGES
USE OF
BUILDINGS 1 ROB* CONNECTION CHARGE FEET \
NO. DESCRIPTION OF WORK FEE \�
HOUSE.SEWER CONNECTING TO REIMBURSEMENT FEES
PUSLIC SEWER = 3.50 RECEIPT NO." \I DATE /IBY�
HOUSE SEWER CONNECTING TO
P RIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER-0-IR REPAIR EXISTING .. NO. VpATE 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 7- DEPTH Q
CESSPOOL-DRYWELL
_ 4411
SPECIAL CONDITIONS ONLY 2.00 p //// MANHOLE REFERENCE
n FUPP ER 'MWER
TYPE'OF CONNECTION LENGTJLFR[IM
OWNERS PERMIT { 1 00 v. . cuae P.L. �� M+L!TD P.L.
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING I APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-------_-----------DAY OF..............._.........,------------19..... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT------------------- ------_--------------_.........._....------...._---------.. BUILDINGORWORK
ADDRESS-----.---._.._.:...._. SEPTIC TANK,SEEP.PIT(S)
_..__......._..._...._._. AND/OR GRAINFIELD
1 .HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL[:) DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE' _
TO COMPLY WITH ALL COUNTY ORDINANCES.AND STATE.LAWSi ALTER,REPAIR.,SEWER OR
REGULATING.PLUMBING AND SEWERS SEWAGE-DISPOSALSYSTEM
.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 RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE ,�//,�/� �j//J ///J SEEP.PIT(S)o CESSPOOLS
OF PERMITTEE.. I...:.._. �^...'Ll=... ._.._� <CL...
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