HomeMy Public PortalAbout10702 LORA ST_Sewer__ ' DEPAKrM[ENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES 1
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 10702. Lora St. CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST �1 14i023tt3 A S
CROSS ST. Tk] aTlt�
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P. L. McNutt
MAIL
ADDRESS 27.ESin Gabriel .Blvd. USE ZONE OCCUPANCY MAP
BK PG
CITY San Gabriel TEL.NO. AT 94364
CONTRACTORLe L. & M* Constraction Go* CO.IMP.NO.
ADDRESS 408 Winthrop Dr*
JOB NO.
CITY Alhambra TEL.NO. AT 48315 TRUNK PERMIT NOSTATE .
REGISTRATiollm3613—C-42 COUNTY
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 18 STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT 17867 INDUSTRIAL
STYE OF LOT NO.OF SLOGS'
WASTE APPROVAL
NOW ON LOT 1 CHARGES
USE OF
BUILDINGS FA$. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE'
PUBLIC SEWER 0 $ 3.50 RECEIPT NO. ( DATE (BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. i DATE !BY
SEWER OR DISPOSAL SYSTEM 1.00 I f
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTIONLENGTH FROM
OWNERS PERMIT $ 1 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 EXITING
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 ............-----------------------------_ --------------- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] DRYWELL E]CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER, REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)E] CESSPOOLS 0
OFPERMITTEE-,..... --------------.._.. --J
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