HomeMy Public PortalAbout10715 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 3 071 fi'Tmrsi, Cita GROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO
� .
_ � xa
NEAREST A S
GROSS ST. E1 Monte Ave, RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
P. L. ImaNutt
MAIL
ADDRESS Z7_2 San Gabriel Blvd, USE ZONE OCCUPANCYMAP
BK PG
CITY San Gabriel TEL.NO. AT 94.364
CONTRACTOR $
I--I)-w mr +oY13faI`t1(it1L131--coo CO.IMP.NO. -
ADDRESS 408 Winthrop Dr
JOB.N0. te`%
CITY Alhambra TEL.NO. AST 48315 ^ z,
TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113C)13—C-42 COUNTY
ROAD PERMIT N0. --- "
LEGAL
DESCRIPTION LOT N0. 9 STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF SLOGS.
NOW ON LOT 2CHARGES
USE OF
BUILDINGS 1 Il@S+ CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
@PUBLIC SEWER $ 3.50 I RECEIPT NO. ( DATE I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDIT'iONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
NO—ALTER OR REPAIR EXISTING
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 I STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
UPPER tCWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I I 00 Y. cup's P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE i
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS-------------.......DAY OF..................._......_.-_....... NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...........-....--..................-......_......_.._..........
BUILD!NG OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS_........................----------------------.......................................... AND/OP.DRAINFIELD
I 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
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND
ABANDON HOUSE PLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)0 CESSPOOLS
SIGNATURE
OF PERMITTEE --..__................. ........___...... ..................---------
i i
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