HomeMy Public PortalAbout10708 LORA ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
' DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 10708 Long $t r CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST
3- a��,., � A S
ROSS ST. Vr1.—mnni-A Aya.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER Pr �+r RCN1Lltt
MAIL
ADDRESS .7 Saxe brj@1 1�I,Vdr USE ZONE OCCUPANCY BK MAP PG
CITY San GabriSlTEL.NO. AT 94364 I
CONTRACTOR T, L T a.trn� - inn on a o �' la� n CO.IMP.NO.
ADDRESS 408 l7inthrop Dr. JOB.NO.
CITY Alhmbra TELAO. AT 48315
TRUNK PERMIT NO.
STATE
REGISTRATION NO. Im COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 17 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
OW ON LOT CHARGES
USE OF '�}
BUILDINGS 1 KIDS. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ ; 3.50 RECEIPT NO. ( 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• DATE I BY
_ SEWER OR DISPOSAL SYSTEM 1.00 I
DISCONNECT AND ABANDON SEWER
AND{OR DISPOSAL SYSTEM 1.001 1 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
—I UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I I 00 Y. 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 I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
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 I HAVE READ THIS APPLI- CESSPOOL I] DRYWELL
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
I 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)EI CESSPOOLS
OF PERMITTEE.._ - ----------------------.........:......
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