HomeMy Public PortalAbout10721 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 lonimiloann St• CROSS ST.
DISTRICT NO. SERIAL NO. PERMIT NO.
LOCALITY 7.1 Monte A 3
c
CROSS STTo 3iionte Ave
NEAREST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER ,p ° 7xtti
-� Lr
MAIL USE ZONE
ADDRESS '..'r�' S" Gabriel Blvd• OCCUPANCY MAP I
CITY San Gabriel AT 94364 1 BK PG
TEL.NO.
CONTRACTORT'•D, & mr construction Go• CO.IMP.NO.
ADDRESS 408 Winthrop Dr• JOB.NO.
CITY .Alhambra TEL.NO.
AT 48315--
TRUNK PERMIT NO.
TATE
REGISTRATION NO. 113613.. C -- 42 COUNTY
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. ,`>r`Z STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS 1 11®g r CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
1 PUBLICSEWER @ $ 3.50 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL SLDG.OR I EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- DATE i BY
SEWER OR DISPOSAL SYSTEM 1.00 f
DISCONNECT AND AWANDON'SEW€R
AND/OR DISPOSAL SYSTEM_ t.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
_ PITS AND/OR DRAINFIELD 2.00 ( STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
UPPER LOWER
i TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ I 1 00
AUTHORIZATION I TOTAL FEE 1 —
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
t HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL E]
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
1 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 I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)0 CESSPOOLS
OFPERMITTEE--------------_------------------..... •-----------------------
76A642D 663 1/53