HomeMy Public PortalAbout10709 MILOANN ST_Sewer__ r 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
ADDRESS 10709 n NEAREST
g
1r1�jOF3,T1]1 ;fit• CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
--mm Monte A S
NEAREST ,
CROSS ST. E iylontaye a
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P. La McNutt
MAIL
ADDRESS 2722 San Gabriel Blvd. USE ZONE OCCUPANCY MAP
BK PG
CITY San G,brielTEL.NO. AT 94$6$
CONTRACTOR 7,. T} k• CDnatr]L,
tinnan, CO.IMP.N0.
ADDRESS 408 ,Winthrop Dr, JOB.NO.
CITY Alhambra TEL.NO, AT 46315
TRUNK PERMIT N0.
STATE
REGISTRATION NO. 42 COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 2C) STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17667 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT �+ CHARGES
USE
BUILDINGS 1 Res* CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
1 PUBLIC SEWER 3.50 RECEIPT NO. ( DATE f 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 N0. I DATE (BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECTAND ARAMESEWER
—2"D/OR
D/OR DSSPOSAL SYSTEM
CONNECTION DATA I.00 �
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR D.RAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWEIL
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 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
SEPTIC TANK,SEEP.PIT(S)
ADDRESS----_------------------•--•------ - ------------------.-. AND/OR DRAINFIELD
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[] DRYWELL
GA NON 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
ST
AND/ LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
A11D STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)0 CESSPOOLS
OF PERMITTEE_. ------- -------- ----
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