HomeMy Public PortalAbout10714 LORA ST_Sewer__ DEPARTMENT OF COUNTY ENGDMER SEWER-SEWAGE DISPOSAL 1
DIVISION OF iSUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 10714 Lora Ste CROSS ST.
LOCALITY Ll Monte DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST. R, 11ante Aver
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P'L, Mite Ltt
MAIL ADDRESS 27- San Gabriel Blvd. USE ZONE OCCUPANCY MAP
SK PG
CITY San G,t'abri6lTEL.NO. AT 9436$
CONTRACTOR L, pr & Xa CON31RUCTION CO* CO.IMP.NO.
ADDRESS 408 'Rinthrop Dr. Io6.No.
CITY ham r'a TEL.NO. TRUNK PERMIT NO.
REGISTRATION NO. 113613-C-42 (El STATE
❑ COUNTY ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOCS'
NOW ON LOT l CHARGES
USE OF
BUILDINGS 1 RBS. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
1 HOUSE SEWER CONNECTING TO
PUBLICSEWER_ Q $ 3.50 RECEIPT NO. DATE I BY
HUUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR i EXCEPTION RECORDED
—
WORK TO HOUSE SEWER 1.00 I
ALTER OR REPAIR EXISTING NO. DATE I SY
SEWER OR DISPOSAL SYSTEM 1.00 I }
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAIN_FIELD 2.00 I STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 I MANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT I 00
Y. CURB P.L. M.L.TO P.L.
; �
AUTHORIZATION I TOTAL FEE I —
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..............._..... ...I9........ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.......................... _ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.---------------............._.-..................................... ------ AND/OR GRAINFIELD
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 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 SEPTIC TANKS E]
SIGNATURE SEEP.PIT(S)o CESSPOOLS
OF PERMITTEE.-.. ----- ........
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