HomeMy Public PortalAbout10721 LA ROSA DR_Sewer__ DEPAItrMENT OF COUNTY ENGINEER, SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY EN61NEER BUILDING - /
ADDRESS
LOCALITY
F
OR APPLICANT TO-FILL M � //j7
BUILDING7'1,1 La Rosa St• - 'CROSS`ST. �-� /r;;'4e Ap-et
TO
MGn hA DISTRICTNO. SERIAL NO.
//N 0. PER(M�IT NO./
A G' 53?J —4' J
Mnntn Avs -
RECEIVED'BY ` Ready for I m0eetion DATEISSU`EDp
L• �CRntt •
ADDRESS 27Zy San Gabriel Blvd. - USEI2ONE OCCUPANCY BK MAP PG
CITY San GabrielTEL.NO. AT 94364
CONTRACTOR L=TL& M_ CONSTRTTCTICN CC, CO.IMP.NO. - - —
ADDRESS 406 Winthrop Dr. JOB NO.
CITY Alhambra TEL.NO. AT 48315
TRUNK PERMIT NO.
$ STA
REGISTRATION NO. II SBI$ C 4Z ❑ COUNTTEY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. 46 PERMIT NO.
BLOCK TRACT 17867 -INDUSTRIAL
WASTE APPROVAL
N0.OF BLOTS. \
SIZE OF LOT NOW ON LOT CHARG ESQ
USOF
BUELDI NGS 1' Re a. -
CONNECTION CHARGE FEE/ --�, f
NO. DESCRIPTION OF WORK FEE / �-
HOUSESEWERCONNECTING TO REIMSURSEMENTPEE
PUBLICSEWER ® = 3.50 RECEIPT NO.HOUSESEWER CONNECTING TO DATE � BY,,"
PRIVATE DISPOSAL SYSTEM 1.00 -
CONNECT ADDITIONAL BLDO.OR EXCEPTION-RECORDED
WORK TO HOUSE SEWE R 1.00
ALTER OR REPAIR EXISTING NO' ( DATE I 13Y "
SEWER OR DISPOSAL SYSTEM 1.00 `
DISCONNECT.AND ABANDON SEWER
AND/OR.DISPOSAL SYSTEM 1.00 CONNECTION`DATA
SEPTIC TANK,SEEPAGE PIT OR �L/
PITS AND/OR DRAINFIELO 2.00 STATION �'T(��� r DEPTH Gj d
CESSPOOL—DRYWELL _
SPECIAL CONDITIONS ONLY 2.00 '179E414/''j ORER REFERENCE Q LOWER
,,.YPE OF CONNECTION V/ LENGTNEROM
OWNERS PERMIT i I 00 •V. CURB- P.L. �M:L TOP.L.
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE PATE
DWELLING TO THE PUBLIC SEWER
SIGNED.THIS------------------DAY OF-------_._.............._..-._.._.19_..- NEW HOUSE SEWER �Qw j'! -1/ --0
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.......................-------------_............_............_........ ' BUILDING OR WORK
EPTIC
TANK
ADDRESS----------------_------_--- -PND/OR O RAI NFIELD IT(S)
I-HEREBY-ACKNOWLEDGE THAT 1 HAVE.READ THIS APPLI- ' CESSPOOL DRYWELL'�
CAT
ION AND STATE THALTHE ABOVE IS CORRECT AND AGREE
TOCOMPLYWITH ALL COUNTY ORDINANCES AND STATE LAWS '.,ALTER,-REPAIfl;SEWER-0R
REGULATING PLUMGING AND SEWERS: SEWAGE'DISPOSALSYSTEM -
1 R AND
HEREBY -CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG
AND/OLICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSESAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL �PROPERTY. BACKFILL SEPTIC TANKSE3
SIGNATURE Ao ftl l .`/-m SEEP.PIT(S)0 CESSPOOLS.
OF PERMITTEE---fly /� �"� L
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