HomeMy Public PortalAbout10709 LORA ST_Sewer__ * DEPA3i,iMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILD!NG
• ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS _. +rLJ IrDrB • CROSS ST.
LOCALITY EL Monte DISTRICT NO. SERIAL NO. PERMIT NO.
NEARESTA S
GROSS ST, El Monte Ave*
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER Po T,' mc-Nutt
i
MA?L
_ADDRESS 272-1 San rgbriel _Rl_yEj. USEZONE OCCUPANCY BK MAP PC
CITY San Bariel TEL.NO. AT 94304 -
CONTRACTOR L. D• & tiT• CnnpItrUp Ori CO.IMP.N0.
ADDRESS 408 Ninthrop b'r, JOB NO.
CITY z1harabra TEL.NO.
TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613-0-42 COUNTY
- ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACTlry��ry INDUSTRIAL
i / WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT + CHARGES
USE OF
BUILDINGS 1 Res, CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
L I PUBLIC SEWER_ @ $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR
EXCEPTION RECORDED
kJO4K TO HOUSE SEWER_ 1.00 -------
ALTER OR REPAIR EXISTING NO- 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—DRYWELL `
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER-
TYPE OF CONNECTIONLENGTH FROM
OWNERS � I 00
Y. CURB P.L. M.L.TO P.L.
PERMIT
AUTHORIZATION TOTAL FEE
I 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................_................_...19..._... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...................................................................__. BUILDING OR WORK
ADDRESS......---------------... SEPTIC TANK,SEEP.PIT(S)
-- -- - - ... - ...... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL E] 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)0 CESSPOOLS I!
OF PERMITTEE_,_;:_ - - - _.:-.......-
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