HomeMy Public PortalAbout10720 LA ROSA DR_Sewer__ DEPAWrMENT OF COUNTY ENGINEER ' . SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING.AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES. /
WILLIAM J. FOX. COUNTY ENGINEER I BUILDING
ADDRESS /0720 LG. /CA S4- ST
FOR APPLICANT TO FILL IN LOCALITYBUILDING
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ADDRESS 10720 LB. Rosa $ .. CROSS ST.NEAREST //id y1 TG /ale
LOCALITY El Monte DISTRICT NO. SERIAL NO. PERMIT NO.
CROOSSST. El Monte Ave. ° (,.l X335 S/ S
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER Y T. McNutt �l./e � `l/-"/MAIL
-5.3
ADDRESS 272- San Gabriel Blvd. USE ZONE OCCUPANCY BK MAP PG
CITY San GabrielTELAO•AT 94364
CONTRACTOR L.D. & M. CONSTRUCTION CO* CO.IMP.NO. --
ADDRESS 408 Winthrop Dr. JOB NO. C
CITY Albambra TEL.NO.AT 48315
TRUNK PERMIT NO.
RE LEGAL
TION1Nb3613 C 42 STATE
LEGAL 4 COUNTY ROAD PERMIT NO.
STATE ENCROACHMENT
DESCRIPTION LOT NO. Ftl PERMIT N0.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
NCHARGES
/ \
SIZE OF LOT N0.OF BL \
OW ON LOT
Y `.CH ARG ES
BUILDINGS Z $e8•USE OF CONNECTION CHARGE FEES
N0. DESCRIPTION OF WORK FEE i
HOUSE SEWER CONNECTING TO REIMBURSEMENTFEE
PU BLI0 SEWER @ $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR ' EXCEPTION.RECORDED
WOItKTO HOUSE S EWER 1.00
ALTERS R REPAIR EXISTING NO,�I ` DATE I13Y
SEWER OR DISPOSAL SYSTEM 1.00 �-
DISCONNECT AND ABANDON SEWER
AND/OB DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION 9 DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 '/ZO MANHOLE REFERENCE
c,7` 'UPPER �hOWER
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
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS--------------------DAY OF.............._...................19._.._ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..........._...._._......_.._......_.._.._......_.._.._......_.._..._ BUILDING OR WORK
SEPTIC TANK.,SEEP.PIT(S)
ADDRESS:...._...._.._......_.............._.._._...._....._...._..-.._....._.._......_. .ANO/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL Q DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR.SEWER OB
REGULATING PLUMBING AND SEWERS.- SEWAGE DISPOSAL SYSTEM
I 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
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS El
SIGNATUREs/�//I�/yt�j�/// SEEP.PIT(S)� CESSPOOLS
OF PERM ITTE E._A- :.^SS.._......... ..Y_ ...__.
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