HomeMy Public PortalAbout10732 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
I ADDRESS
FOR APPLICANT TO FILL IN LOCALITY _i
BUILDADOREING SS 10732 Lora Ste NEAREST
CROSS SL
LOCALITY Fl blare C 9 DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST. Lel Monte Ave,
RECEIVED BY Ready for inspection DATE ISSUED
OWNER po L•MAIL
CBT1Z tr
ADDRESS 272Q San Gabriel Blvd* USE ZONE OCCUPANCY MAP
BK PG
CITY San GabrielTEL.NO. AT 94364 4f
CONTRACTOR
-- —mss 1)-s—&-- r0+I•?ns trufv't i®m# Cr 0 s CO.IMP.N 0.
ADDRESS 408 7Jinthrop Dr• JOB.NO.
CITY Alhambra TEL.NO. AT 48315 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613-C-42 (� COUNTY
ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. 13 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17a87 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT CHARGES
USE
BUILDINGS l Re8• CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER a $ 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. f DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
UISCONNtCT AND ABANDON SEWER '
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
_ UPPER !OWER
TYPE OF CONNECTION LENGTH FROM
Y. CURS P.L. M.L.TO P.L.
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE ! —
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 ;T
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT-.-._.._..----...._......................>.
...........-•---....._............ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS--...... ----------------------- ••--•............._........- ......... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ 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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/CSR 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)❑ CESSPOOLS
OF PFRMITTEE_a `- --- ... -.
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