HomeMy Public PortalAbout10726 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
BUILDINGEAREST
ADDRESS 10726 Mi.loann Ste CR SS ST.
LOCALITY ]&l Monte DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST. Ea. Monte Axe* —
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P. T" Mnxutt
MAIL
ADDRESS 27 San Gabriel Blvd r USE ZONE OCCUPANCY ! SK MAP PG
CITY San GabrielTEL.NO.'AT 94364
CONTRACTORLr 1). & M. CanstrUCtion COr CO.IMP.NO.
ADDRESS 408 Winthrop Dr. JOB.N0,
CITY A.lh=bra TEL.NO. AT 46515 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 11 2SAI COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. 26 STATE ENCROACHMENTPERMIT 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
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADD(fl-6 AL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAfR EXISTING NO. I DATE (13Y
SEWER OR DISPOSAL SYSTEM 1.00
---------- -_` -- - --
DISCONNECT AMD ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 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
TYPE OF CONNECTION LENGTH-F^nGivi
OWNERS PERMIT $ 1 1 00 Y CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE I —
1 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 I HAVE READ THIS APPLI- CESSPOOL E] 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
1 HEREBY CERTIFY THAT IAM 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)E] CESSPOOLS 0
OF PERMITTEE...._.__...._.............____---------------'-------- 1
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