HomeMy Public PortalAbout10727 LA ROSA DR_Sewer__ D£PAKTMENT OF COUNTY ENGINEER, SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES. -
WILLIAM J. FOX. COUNTY ENGINEER ADDRESS to 7;Z 7 Rr9,S
FOR;APPLICANT TO•FILL IN LOCALITY
GUIDING :NEAREST / �G/_ ,vl� .�
.ADDRESS 10727 La Roaq 'St. `GROSSEST: �{�( f"'r/ !dTkl
LOCALITY Sl MOIIt6
DISTRICT NO. SERIAL NO. "PERMIT NO.
CROSRSST.El Monte Ave. '4 0 s.
-
RECEIVE))BY Reedy for Inspection OATE ISSUED
OWNER p eL McNutt ,/,
- MAIL US�20NE OCCUPANCY MAP
ADDRESS 27* Sart (`4715.161 RTOfI BKPG
DiSv San GabrielTEL'N0' AT 94Rf,4
CONTRACTOR L.D. & M. CONSTRUCTION Coe CO.IMP.NO. -�—
ADDRESS 408 Winthrop Dr. -
JOB N0.
CITY Alhambra TELAO.- At 48glB TRUNK PERMIT NO.
TI
REGISTRATION NO. 113613 C 4P. COUSTANTYE ',
LEGAL ROAD PERMIT NO. r�
; \ '
DESCRIPTION LOT NO. T}7 � STATE ENCROACHMENT PERMIT NO.
BLOCK TRACT 17867 ! .,INDUSTRIAL0.OF
WASTE APPROVAL /� \
SIZE OF LOT NOW OX LOTS 1 I \ 'CHARGES
USE OF 1 DINGS lies,
BUILDINGS CONNECTION CHAR E'FEE �' J
No. DESCRIPTION OF WORK FEE I !N
OUSE'SEWER CONNECTING TO
H ,I REIMBURSEMENT FEE
Z PUBLIC SEWER @ $ 3.50 } RECEIPT NO. I AT` IBY
HOUSE SEWER CONNECTING TO , \
PRIVATE DISPOSAL.SYSTEM IAO
CONNECT ADDITIONAL BLDG.OR ' EXCEPTION RECORDED
WORK TO 14OUSE SEWER: -. 1.00
ALTER OR REPAIR EXISTING .�"0' I DATE 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 ANO/OR GRAINFIELD 2.00 STATION_442 DEPTH Zo
CESSPOOL-DRYW ELL
SPECIAL CONDITIONS ON LY 2.00 O MANHOLE REFERENCE C
L4 PC�UPP ERS O'YLOWER
TYPE OF CONNECTION LENGTH-FROM'
OWNERS PERMIT $ I 00 Y/ CURB- P.LL- MIC TO'P,.L:+'r�
AUTHORIZATION LTOTAL FEE
HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMEDI'
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGI APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING-TO THE PUBLICSEWER
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-DRAINFIELD
-1.HERESYACKNOWLEOGE.THAT 1 HAVE READ THIS APPLI. '.CESSPOOL[:] DRYWELL
CATION AND.STATE THAT ITHE ABOVE IS CORRECT,AND AGREE
TO:COMPCY,WITH ACL COUNTY''ORDINANCES AND STATE LAWS ALTER,REPAIR.,SEWER OR
" PECULATING PLUMBING AND;SEWERSi SEWAGE DISPOSAL SYSTEM _
I HEREBY bERTIFY 'THAT I AM PROPERLY REGISTERED L 'DISCONNECT PLUG AND
. AND/OR LICENSED AS REQUIRED BY LOS ANGELESCOUNTY
AND:STATE OF CALIFORNIA OR THAT I:AMTHE EGAL OWN. ARAN ON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESID/DEEENNTITIALL/PROPERTY. /J/f BACKFILL SEPTIC TANKS
SIGNATURE
SEEP.PIT(S)0 CESSPOOLS
OF PERMITTEE...... tt'..._... :..._... ........_ .. .... -
76A642D 663. 1/53: