HomeMy Public PortalAbout10721 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 107?,] Long qt CROSS ST.
LOCALITYDISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST � OTlt A S
GROSS ST. El Monte Ave•
RECEIVED BY Ready for Inspection. DATE ISSUED
OWNER POT.-MAIL
IYiCNti t
ADDRESS 272j San Gabriel Blvd. USE ZONE OCCUPANCY SK MAP PG
CITY, San Gabriel TEL-NO- -AT 94364
CONTRACTOR- Or SSD IfitL'iC.ti CO.IMP.NO.
ADDRESS 406 Winthrop Dr, JOB.NO.
CITY -klb=bra TELAO, AT 4831kj TRUNK PERMIT NO.
�] STATE
REGISTRATION N0. 361a3'-C-42 N COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. 14 PERMIT NO.
BLOCK TRACT 17667 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT `? CHARGES
USE
BUILDINGS 1 E®.>• CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
l PUBLIC SEWER 0 $ 3.50 I RECEIPT NO. ! DATE I BY
HOUSE SEWER CONNECTING TO
_ PR!VATE DISPOSAL SYSTEM 1.00 '
60NNECT ADDITIDNAI BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTEROR REPAIR EXISTING NO DATE `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 I MANHOLE REFERENCE
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 —
I 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............_....._......._..........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 0 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 PLU!l.BING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED DISCONNECT PLUG AND
A.ND/ LD AS REQUIRED BY ANGELES COUNTY ABANDON HOUSE SEWER
ANDST STATEE OF OF CALIFORNIACAM OR THAT AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]
SIGNATURESEEP.PIT(S)❑ CESSPOOLS
OF PERMITTEE.-, _...-.._.
6A642D 663 1/53 W