HomeMy Public PortalAbout10733 LA ROSA DR_Sewer__ DErAxrnIENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES,
WILLIAM J. FOX, COUNTY ENGINEER BUILDING n
' - ADDRESS /D / �_� L� .YT S/2 ✓�
FOR APPLICANT TO 'FILL IN LOCALITYRUILDING
ADDRESS, 10733 LaRosa. St, KNEARESTLOCALITY $l Monte ♦ /SERIAL NO. . PEERMIITNO.
NEAREST A 4pJ�CROSSST. '$1 MDIlte gYeReady for Inspection DATEISSUED
OWNER P.L• McNuttMAIL
ADDRESS 27Z32- San Gabriel Blvd. USIf ZZONEE j OCCUPANCY 7BK MAP PG
J
CITY San Gabrie EL.NO. T 4364 �S ---
CONTRACTOR L. ➢. & M. Cnr Rt r32A IT11 CD, CO.IMP.NO.
ADDRESS 408 Winthrop Dr. )OB NO.
CITY Alhambra TEL.NO_ T 48315
TRUNK PERMIT N0. -
REGISTRATION NO. 113613 C 42 yy STATE
uu COUNTYROAD PERMIT N0. _
LEGAL STATE ENCROACHMENT \
DESCRIPTION LOT N0. 48 PERMIT NO.
BLOCK TRACT 17867 tINDUSTRIAL
512E OF LOT NO-BF BLDGS. WASTE APPROVAL
NOW ONLOT '� /CHARGES it
USE OF
BUILDINGS 1 Res. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE /•
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER Q $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWERCONNECTING TO / I/
PR IVATE DISPOSAL SYSTEM L00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED`
WORK TO.HOUSE SEWER - 1.00
ALT EROR.REPAIR EXISTING NO. I GATE- BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT.AND ABANDON SEWER
AND/OWDISPOSAL SYSTEM 1.00. CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 .STATION DEPTH
CESSPOOL-ORYWELL
SPECIAL CONDITIONS ONLY 2.00 � 1,, MANHOLE REFERENCE�yy G$Y'- UPPEN- Q-,-'- LOWER
TYPE OF CONNECTION �- LENGTH.ERGM—
OWNERS PERMIT = 1 00 V!- CURB%'" P.L. M-L:TO"P.L.
AUTHORIZATION I TOTAL FEE
I 'HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
, CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
.DWELLING TO THE PUBLIC SEWER
SIGNED:THIS........------------DAY OF ----.................... _19-..--_ NEW HOUSE SEWER -
OWNEROR CON NECT ADDITIONAL
"OWNERS AGENT__-..-_------_-_..-..._--------------_--.---.----_---.-..----.-......._r' RUILDING,OR WORK
" ADDRESS :--._ - SEPTIC TANK:SEEP.PIT(S)
------- ------ ------ -- 'AND/OR.DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL'0 ORYWELL
CATION.:AND STATE THAT THE ABOVE-IS CORRECT.AND AGREE:I
TO COMPLY WITH ALL COUNTY'ORDINANCES AND STATE LAWS! ALTER. REPAIR,SEW ER OR
REGULATING iPLUMBING AND'SEW SEWERS. ALTER.
DISPOSALSYSTEM
I THEREBY CERTIFY THAT 1 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 HOU SE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]
SIGNATURE /� G` SEEP.PIT(S)Q CESSPOOLS
OF PERMITTEE-.