HomeMy Public PortalAbout10219 NADINE ST_Sewer__ I
DEPASTbffi�1'1' OF COUNTY ENCENEER i SEWER—SEWAGE DISPOSAL 9 511
DMSION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOB "COMM i
WILLIAM J FOX, COUNTY ENGINEER � ADDRESS�Q i../
FOR APPLI NT TO FILL IN LOCALITY
47
BUILDING NEAREST
ADDRESSp2 tilil� CROSS ST
LOCALITY DISTRICT NO SERIAL NO PERMIT NO
NEAREST S— A 196-X8 S
CROSS ST E IVE BY Ready for Inspection DATE ISSUED
OWNER
MAIL USE TONE OCCUPANCY BK MAP PG
ADDRESS
CITY TEL NO I
CONTRACTOR California Sewer Const.Co.
CO IMP NO 44 di
ADDRESS 1317 Colegrove Ave.
JOB NO
CITY Montebello TEL NO UNion 1-5048 TRUNK PERMIT NO --
��$$TT��
REGISTRATION NO 104"15 5�009NTY ROAD PERMIT NO
DESCRIPTION LOT HO I7 IC3 ���Su
STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT 4 07, WASTE APPROVAL
812E OF LOT , NO OF SLOGS I
Ab NOW OU LOT t CHARGES
USE OF
BUILDINGS CONNECTION CHA E FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
PUBLSWRCONNETO
IC EE .4 a $ age RECEIPT NO DATE BY
HOUSE SEWER CONNECTING TO 4
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION R ED
WORK TO HOUSE SEWER 100 NO ATE BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 100 -
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CON ION DATA
SEPTIC TANK SEEPAGE PITON /
PITS AND/OR GRAINFIELD 2 00 STATION J44,r% , DEPTH (O
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 / Q ,L f MANHOLE REFERENCE /LOWER
TYPE OFO sECTI PL LENGTH MLTOPLOM
R OWNERS PERMIT $ 11 00
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HERE NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBEDXIE STING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS a�0 Y OF _ ly NEW HOUSE SEWER
K
OWNER OR _ CONNECT ADDITIONAL
OWNERS AGE _ BUILDING OR WOR
ADDRESS �� AND%OR GRAINFIELD PIT(S) '
G - 9 - _
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL 13 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 DISPOSALSYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/STATE OFSCALIFORNIAUOR THAT 1 AM ANGELES
OWN ABANDON HOUSE SEWER
ER OF THE ABOVE DE IBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑
SIGNATURE W/,l BEEP PIT(S)0 CE88P010LS `.
OF PERMITTEE'%J/� _7_ _ _ __
T0A042D 063 1/53