HomeMy Public PortalAbout10733 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 10 SM Ifil()811'I1 St. CROSS ST.
LOCALITY .t'KJ MOnte DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A S
CROSS ST. �� OYttOY •
-- RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P,L. AJtmNutt
MAIL
ADDRESS '�„�°� San Gabriel Blvd. USEZONE OCCUPANCY BK MAP PG
CITY a&,h ri wl TELAO.Aj�-� ►@A
CONTRACTORL• I)• & Us ConstT'11G'•'�ij-O?AstCt00, CO.IMP.NO.
ADDRESS 408 Idinti rop Dro
JOB.N0.
Alhambm
AT 4643IB_
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 C $2 COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS 1 lea, CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $ 3.50 I RECEIPT NO. � DATE �BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL SLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NU. DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00 I `
—61SCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 ( CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR I
_PITS AND/OR DRAINFIELD 2.00 I STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCE
UP-PER LOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT I
Y. CURB P.L. M.L.TO P.L.
( 00
AUTHORIZATION TOTAL FEE
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•................._....._ ... 14..__.. NEW HOUSE SEWER
OWNER OR _ CONNECT ADDITIONAL
OWNERS AGENT---•-•--•-•..........................••---•-.........._..........---•-----
BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS--------•..................._..._...., .............-•----------- AND/DR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] 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
I HEREBY CERTIFY THAT 1 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)E] CESSPOOLS[]
OF PERMITTEE:.:-.----------------------------------........•................. -
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