HomeMy Public PortalAbout10703 LORA ST_Sewer__ 3' DEPAIVrMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
s DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OI' LOS ANGELES
• WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADORESS]d'f o$ �rO -a Street CROSS ST.
LOCALIT'Sl Uonte DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS STI ATnn t Qe �t�R
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER �` �� Bitc.'ItTlatt
MAIL
ADDRESS 72s. San (1aabri al Rlyd, USE ZONE OCCUPANCY MAP
BK PG
CITY San Gabriel TEL-NO- AT 94364 I(
CONTRACTOR L.3). & M. Congtrllation Co. CO.IMP.NO.
ADDRESS 408 ffinthrop Dr• JOB NO.
CITY Alhambra TEL.NO. AT 48315 TRUNK PERMIT NO,
TE
REGISTRATION N0. 11!{ �� {;��' STACOUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT No. 7 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
NO.OF BLDGS.
SIIE OF LOT NOW ON LOT CHARGES
USE OF
BUILDINGS 1 ReS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLIC HEWER @ $ 3.50 RECEIPT N0. + DATE i 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 i DATE I 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 AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—D RYW ELL
_SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER `LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. CURE 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 EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS....................DAY OF....._.......................-..........14_,._._. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL i
OWNERS AGENT..................----......................... BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS----------........................................._..........................__..........._ . AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL_n
CATIONAND 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
I HEREBY CERTIFY THAT IAM 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 SEPTICTANKS(�
SIGNATURE SEEP-PIT(S)o CESSPOOLS 11
OF PERMITTEE ...... ....
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