HomeMy Public PortalAbout10714 MILOANN 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 L() 14 �,OP-3333 .3t s CROSS ST.
LOCALITY ]&l XOnte DISTRICT NO. p SERIAL NO. PERMIT NO.
NEAREST
ST, ElmMonte AVeo _ A S
CROSRECEIVED BY Ready for Inspection DATE ISSUED
OWNER P• L. TInh-atit
MAIL
ADDRESS 27,2-21-- San��Gabriel Blvd USE ZONE OCCUPANCY BK MAPQau PG
1124
CITY &j"jgbgj TEL.NO. /LING. 94364
CONTRACTOR L. Lr & Ide (`rAnStX`L1CtriOY 00- CO.IMP.NO.
ADDRESS 406 71inthrop bre Io6.No.
CITY Alhambra TELAO. 8T 48315 TRUNK PERMIT NO.
REGISTRA7fON NO.73vxgs�y (+ ,gI STATECOUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. g STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS 1 qeS, CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
_1_PUBLIC SEWER @ S 3.50 IRECEIPT NO. I DATE 1 BY
HOUSESEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTERR OREPAIR EXISTING NO' I DATE - I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM Loo I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/OR DRAiNF1ELD 2.00 I STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
i UPPER LE'.:aR
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; 1 00
Y. CURB P.L. M.L.TO P.L.
�
AUTHORIZATION I 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...... _......19NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT........................................._._........__.................... BUILDING OR WORK—
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.......................•------_-----..................--------.__......._,................. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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
1 HEREBY CERTIFY THAT 1 _
PROPERLY REGISTERED DISCONNECT PLUG AND
AND/ST LICENSED REQUIRED BY LOS ANGELES COUNTY
AND STATE OF CALIFORNIABY
OR THAT I AM THE LEGAL OWN-
ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS(�
SIGNATURE SEEP.PIT(S)❑ CESSPOOLS[j
OF PERMITTEE-- ---- ----------- -..---------------------..............---
76AG421) 663 1/53