HomeMy Public PortalAbout10715 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 �rr9j]pgnn s` . CROSS ST.
LOCALITY 1NI�I1t� DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST. Unn+js k3E I
_7 RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P.L. .MC Nutt
MAIL ��,y,
ADDRESS 2r7!F+iit San Gabriel Blvd* USE ZONE OCCUPANCY BK MAP PG
CITY San GabrislTEL.NO. AT 94364
CONTRACTOR, Di & M. Construction Coo
CO.IMP.NO.
ADDRESS 406 Nin.Lltrop DP•
JOB.NO.
CITY 41hambra TEL.NO. AT 48316 _
TRUNK PERMIT N0,
REGISTRATION N0. 113613 C.. 42H STATE
COUNTY
ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. 2I PTATE
ERMIIT NNOROACHMENT
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS 1 ReS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER _ 0 $ 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- DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00 I
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
i CESSPOOL—DRYWELL
1 SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
UPPER LOWER
i TYPE OF CONNECTIONLENGTH FROM
OWNERS PERMIT $ I I OD
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
SEPTIC TANK.SEEP.PIT(S)
ADDRESS................. - -------------------............ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL❑ DRYWELL E]
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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)D CESSPOOLS
OF PERMITTEE------ ---------------- ------............... ....
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