HomeMy Public PortalAbout10310 LIVE OAK AVE_Sewer__ D
5&E-683 3.65 APPLICATION- FOR ■ ERMIT
4&E-8
DIVISION OF BUILDING AND SAFETY I SEWER-SEWAGE DISPOSAL.
Department of County Engineer
County of Los Angeles BUILDING 10310 hive Oak
WM.J. FOX. COUNTY ENGINEER. ADDRESS
CASSATT D. GRIFFIN, SUPT OR BUILDING ,LOCALITY Temple City
MMMOMFOR APPLICANT TO FILL IN NEAREST T
'LEGAL. d, /:10
L CROSS ST.
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DESCRIPTION LOT NO, VV I 6 0 '0I� OWNER
Funaro
BLOCK TRACT MAIL
ADDRESS
NOOF BLDGS
SIZE OF LOT 1-2_j) x 7_�NOW ON LOT CITY TEL NO.
USE OF �f !Nx 11
BUILDINGS ,Y +fL_/r DISTRICT�•0. ` GROUP BK MAP PG
-- I -�
CONTRACTOR Belvedere Plumbing Co, ly ,2.0
ADDRESS 11900 E. Gaftvey CONNECTION DATA
CITY El Monte TEL. N0. Gi 89836 STATION DEPTH
0 STATE MANHOLE REFERENCE UPPER
REGISTRATION NO 179568 ElCOUNTY
� LOWER
NO. DESCRIPTION OF WORK FEE p� J _5-.57Y
HOUSE SEWER CONNECTING TOTYPE OF 60NNECTib'a LENGTH FROM
Y
PUBLIC SEWER URB P.L M L TO L.
Q
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00 _
1 CONNWORK HOUSE CT ADD SEWER BLDG. OR 1 00 11,00 IMP NO JOB NO
O
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1 00 TRUNK PERMIT NO ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPCCIAL CONDITIONS ONLY 2 00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S 00
AUTHORIZATION TOTAL FEE 3 90
REIMBURSEMENT FEE
IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER
SIGNED THIS -DAY OF 19 NEW HOUSE SEWER
OWNER OR1 CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP, PIT(S)
ADDRESS ,AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION 'CESSPOOL[IDRYWELL C3AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 'ALTER, REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM '
1 HEREBY CERTIFY THAT 1 AM PROPERLY RE TERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COU AND STATE DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OW E OF THE AB 'E ABANDON HOUSE SEWER
DESCRIBED RESI DENTALn PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE
WILLIAM J. FOX,COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR