HomeMy Public PortalAbout10222 NADINE ST_Sewer__ a `nEeAST�NT OF COUNTY ENGINEER � SEWER—SEWAGE DISPOSAL
DMSION OF SVIMING AND SAFETY 9571
� PERMIT APPLICATION
COU14W OF 1,08 ANGZLE8
s WILLIAM J FOX, COUNTY ENGINEER AIDDRENB ^
ADDRESS /.
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FOR APPLI T TO H IN L°D"LITY
BUILDING 9 9 NEAREST
ADDRESS tj0_ i GROSS ST
LOCALITY t DISTRICT NO SERIAL NO PERMIT NO
NEAREST S A Q !L j S
CROSS 8T
C ED B Ready for Iespause DATE ISSUED
OWNER
/- 3-
MAIL
AGGRESS USE ZONE OCCUPANCY MAP
- BK P8
CITY TEL NO
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CONTRACTOR California Sewer Const.Ce_ CO IMP NO /
ADDRESS 1317 Colegrove Ave. JOB NO
CITY Montebello TEL NO UNlon 1-5048 TRUNK PERMIT NO
ATE
REGISTRATION NO 104445 S®EeNTY ROAD PERMIT NOLEG .�
DESCRIPTION LOT NO -/ STATE ENCROACHMENT
9/ PERMIT NO
BLOCK TRAW LO pZ INDUSWASTAPPROVAL
SIZE OF L07 4 ;Lu NO OF BLDOS
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARS EE
NO DESCRIF{ ION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER G $ 300 RECEIPT NO I DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION ORDED
WORK TO HOUSE SEWER 100 NO ATE BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM too
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CO ECTION DATA
SEPTIC TANK SEEPAGE PIT OR f iS O
PITS AND/OR GRAINFIELD 200 STATION DEPTH
CESSPOOL—D RY W ELL
SPECIAL CONDITIONS ONLY 200 / �y
• HOLE R
7 • MANEFERENCE w LOWER
TYPE
OF CONNECTIO LE MOTH FRO
OWNERS PERMIT = 1 pp '— � cr M L TO P L .27
AUTHORIZATION TOTAL FEE s
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
COAPPROVALS INSPECTOR 8 SIGNATURE DATE
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER
SIGNED THIS S D_ _DAY OF_ �� _I NEW HOUSE SEWER c _,s 3
OWNER OR CONNECT ADDITIONAL
OWNERS AGENTG41, _ _ _ BUILDING OR WORK t
ADDRESS!!< >1. _ AND�ORGRAINFIELDlT(8)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL 1] ORYWELL(]
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 THATHI AN PROPERLY REGISTERED DISCONNECT PLUG AND
AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR T AT 1 AM THE LEGAL OWN
ER OF THE ABOVE DESC IBED BIDENTIAL PROPERTY BACKFILL SEPTIC TANKSn
SIGNATURE SEEP PIT(8)0 CESSPOOL$ s'e"Ay'lckk
3
OF PERMITTEW.Zd /
TOA042D 66S 1/03
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