HomeMy Public PortalAbout10404 MILOANN ST_Sewer__ 6A6 ZD
E•663 A PPLICATION FOR PERMIT
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(DIVISION OF BUILDING" AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles BUILDING yy��jj,,����, y�y11T
ADDRESS .sta`Ft,0 Fkilq
WM.J. FOX,COUNTY ENGINEER -- psi
CASSATT D.GRIFFIN, SUPT OF BUILDING LOCALITY Temple City
FOR�iPPLICAN ° TO IFIL(. IN �NEARESr
CROSS ST, -a'
LEGAL
DESCRIPTION^LOT NO.. � _ _OWNER D g0�4, 'Simpson_._Y
BLOCK TRACT - .E` MAIL �- -
_ ✓ .�. ,. ADDRESS
N0. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO,
USE OF
BUILDiNr,S__- �11@I ,g,� �8` i - - - DISTRICT NO. s GROUP MAP
CONTRACTOR MartXerd in ick .. BK PG
ADDRESS 325 I' Sttn.ta Anita CONNECTION DATA
CITY T raid it TEL. NO. -_ &If `�'7`.")'A STATION
R-1-=(7 -6� - �, DEPTH
❑ STATE MANHOLE REFERENCE ,• LPPF.R•_
REGISTRATION NO, ���) ❑ COUNTY
NO. DESCRIPTION OF WORK FEE -- -----
- -- TYPE F dNECTiON LENGTH FROM r'
HOUSE SEWER CONNECTING TO Y. 4-ri
CONNECTINGP.L, Ft_L_TO P.
PUBLIC SEWER @ $ 3.50 ' ,I_- - .--'�,:�,- �----- - -
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 -- -- ---- -
�I
CONNECT ADDITIONAL BLDG. OR P. C. NO.
WORK TO HOUSE SEWER 1.00 --._ CO. ID9P. N.0__ ,�,_ -___JOB NO.
ALTER.OR REPAIR EXISTING ---s - --
_ 5 4 ER OR DISPOSAL SYSTEM _1.00 _-_- TRUNK PER, NO. ROADPERMIT NO, �7
DISCONNECT AND ABANDON SEWER
__,_AND/OR D PERMIT DISPOSAL SYSTEM —1_ORJ STATE NO.
( - -- ----- - ---'-
1ScP7tC T?Nh SEEPAGE PIT OR _ NO
WITS AND/CH DRAINFIELD 2.40 INDUSTRIAL
___c-.. ..._- .__-. -- -_..--_-----` ----- WASTE APPROVAL
C E„SPOOL• DRYWE.LL
SPECIAL CONDITIONS ONLY 2.00 - - CHARGES
FERb413 -�t4 �O CONNECTION CHARGE FEE
AUTHORMATION TOTAL FEE ! � � � : REIIASURSFMEkl FEE
I HAVE THIS DATE C:UNTP,ACTED WITH aHE .HEREIN NAMED CON-
TRACTOR IO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS �_-�-DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER ---"-- -----� --- --- ----
NEW HOUSE SEINER I
SIGNED THIS_.__ DAY
OWNER OR - - CONNECT ADDITIONAL --- __
OWNERS AGENT-____ _ BUILDING OR WORT{
ADCR€SS SEPTIC TANK, SEEP, FIT(S)
4'
'---------'-----'-----_------ --.-e-.-------- _AN Df_OR D_RA1 N_F!€LD
I HERESY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL
AND STATE THAT THE ABOVE IS CORRECTAND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER REPAIR SEWEROR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY ANC STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AIA THE LEGAL OWNER OF THE ABOVE A&ANDON HOUSESEY:�cR _ �.
DESCRIBED RESIDENTIAL PROPERTY, 'BACKFILL SEPTIC TANKS❑ -
SEEP. PIT(S) ❑ CESSPOOLS CA
SIGNATURE
OF PERMITTEE
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PL.8G. INSPECTOR
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