HomeMy Public PortalAbout10225 NADINE ST_Sewer__ y
DEPARTMENT OF COUNTY ENGnncm SEWER—SEWAGE DISPOSAL 1®3 21
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES pp
WILLIAM J FOX, COUNTY ENGINEER ADD ET
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FOR APPLI NT TO fflLL IN ' LOCALITY
BUILDING NEAREST
ADDRESS CRO88 ST
LOCALITYf DISTRICT NO SERIAL NO PERMIT NO
NEAREST s A /p o 3 O S
getCROSS ST
E VED Ready for inspection DATE ISSUED
OWNER L
MAIL
GGRESS USE ZONE OCCUPANCY BK MAP PG
A
CITY TEL NO A - 1 & `
CONTRACTOR California Sewer Concat eggs CO IMP NO
ADDRESS 1317 ColeRrov Avg JOB NO
CITY Montebello TELMOUNiLnnTRUNK PERMIT NO
REGISTRATION NO 104445 /rte Stu ROAD PERMIT NO
DESC IR PTION LOT NO M/LJ•��e�SQ STATE ENCROACHMENT
/- PERMIT NO
BLOCK TRACT INDUSTRIAL
APPROVAL 1
812E OF LOTS Q'Ld NO OF
NOW ON LOTS CHARGES
USE OF
BUILDINGSfrP_O" CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER a $ 330 Sd RECEIPT NO D TE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RDED
_ 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 1 00 CON ION DANA
SEPTIC TANK SEEPAGE PIT OR �9 •S DEPTH f
PITS /OR GRAINFIELD 200 STATION
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 200 2 I MANH�EERREFERENCE w �g LOWER
TYPE OF CONNECTIOLENGTH FROM /
OWNERS PERMIT $ I 1 00 GUS' ML TO P L �2 7
AUTHORIZATION TOTAL FEE a
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR 8 SIGNATURE DATE
DWELLING TO THE PLBLIC,SEWER
SIGNED THISDAY OF _ I NEW HOUSE SEWER
7,Z' a CONNECT ADDITIONAL
OWNERS AGENT_ s_ _ R _ _BUILDING OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS __ �da�es2:� �vL _ AND/OR DRAINFIELD
I HERBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI CESSPOOL[] DRYWELL 13
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBINO AND SEWERS SEWAGE DISPOSAL SYSTEM
I 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 1 AM THE LEGAL OWN
ER OF THE ABOVODESCR ED R IDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑SIGNATURE / SEEPPIT(S)[3 CESSPOOLS S OF PERMITTEE(/
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;aAe42D°z APPLICATION FOR PERMIT `
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DMSION F. R
JOHN A LAMBIE County Engg��nne°r
WILLIAM A IENSEN Sup t of BuEmg
FOR APPLICANT TO FILL IN
LEGALfig
DESCRIPTION LOT NO ✓� OWNER
BLOCK TRACT /&-lys ` MAIL ADDRESS 2,b.5
/�? NO OF
SIZE OF LOT `J✓ NOW ONS
LOTS i CITY TEL NO
USE OF 3^ ry.� DISTRICT NO GROUP BK MAP PROCESSED BY
BUILDINGS IL�s h'/L146C �rhtlt�(ji ■�Rlw• T
CONTRACTOR
ADDRESS sf CONNECTION DATA
CITY T
STATION 3 t 277 1 DEPTHI�J `
EL NO
TATE MANHOLE REFERENCE ��
REGISTRATION NO D COUNTY , V�/ LOWE
NO DESCRIPTION OF WgRK FEE TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO Y CURBp L !!L TOP L 2�
PUBLIC SEWER ® $S 00
SEPTIC TANK SEEPAGE PIT OR J C NO
PITS AND/OR DRAINFIELD $1000
CO IMP NO OB NO
[42HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM f9 00
CONNECT ADDITIONAL BLDG OR 4r AFFIDAVIT WAIY[s I EASEMENT RECORD INSTR NO DATE
WORK TO HOUSE SEWER $300
OVERFLOW SEEPAGE PIT DRAINFIELD
EXTN CESSPOOL DRYWELL MANHOLE! $500
ALTERREPAIR OR ABANDON HOUSE HWY OR ST WIDENING
SEWER OR DISPOSAL SYSTEM 41 $300 STATE ENCROACHMENT
C PERMIT NO
Saw
( INDUSTRIAL
�'E�f! te- ��6 6 WASTE APPROVAL
CHARGES
OWNER S PERMIT S 2 OO
AUTHORIZATION TOTAL FEE S Q/ CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS
TO THE PUBLIC SEWER DATE INSPECTOR S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(S)
{ HERESY ACKNOWLEDGE THAT i HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL ❑ DRYWELL [IPLUMBING AND SEWERS
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER RBPWXWSEWERIR
LICENSED AS REQUIRED BY L ANGLES COUNTY AND STATE OF S
CALIFORNIA OR TH T AL OWNER OF INTEND TO DISCONNECT PLUG AND
RESIDE IN THE OVE E SIDENT L O ERTY ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PERMITTEE SEEP PIT(S) ❑ CESSPOOLS
VALIDATION ROBERT A WOOD
CK M O CASH SUPERVISING MECHANICAL ENGINEER
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