HomeMy Public PortalAbout10228 NADINE ST_Sewer__ DFPARTB ENT OF COUNTY ENG1NF.ER f SEWER-SEWAGE DISPOSAL19 2 p
DIVISION OF BUILDING AND SoFETY I PERMIT APPLICATION
a COUNTY OF LOS ANGELES ^ p�
,, WILLIAM J FOX. COUNTY ENGINEER I ADILDING
DRESS �C l^ �1--$ l�Li�^✓�LIM.Q `
J
FOR APPLICA T TO FILL IN ' LOCALITY
BUILDING NEAREST
ADDRESS CROSS ST
LOCALITY DISTRICT NO SERIAL NO Q PERMIT NO C
NEAREST ✓ A /Q ? J
CROSS ST
RECEIVEO�BY Ready for Inspection //DATE 188
OWNER /- ,5:3
MAIL USEZONE IOCCUPANCY I BK MAP PG
ADDRESS
CITY TELNO
CONTRACTOR California .Sewer Const.CII- CO IMP NO � CL
ADDRESS 1317 Colegrove Ave. JOB NO
CITY Montebello TEL NO UNlon 1-5048 TRUNK PERMIT NO
TATE
REGISTRATION NO 104445 SUaQMNTY ROAD PERMIT NO ---��
LEGAL 8PERMIT NCROACHMENT
DESCRIPTION LOT NO
BLOCK TRACT &g3fl INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT /a NO OF BLDGS I CHARGES
NOW ON LOT
USE DCONNECTION CHARGE FEE
BUILDINGS /
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FE\
HOUSE SEWER CONNECTING,TO
PUBLIC SEWER ! $ 850 f� RECEIPT NO I D F� I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEKTTION RECORDED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING 77F DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT
ND/OR DISPOSAL SYSTEM SEWER 1 00 CONNECTION DATA O
SEPTIC TANK SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD 2.00 STATION 'ft Z O DEPTH V
CESSPOOL—D RYW ELL
SPECIAL CONDITIONS ONLY 200 f MANHOLE REFERENCE \N _J
'Y LOWER
TYPE OF CONNECTIO LENGTH FROM
OWNERS PERMIT = 1 00 Y- cmeB- P L ML TO P L Z7
AUTHORIZATION TOTAL FEE
1 N HAVE THIS DATE CONTRACTED WITH THE HERE NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWEJR�-�.
SIGNED THIS/ DAY OF fL v� IkIca NEW HOUSE SEWER SclAra
OWNER OR CONNECT ADDITIONAL
OWNERS AGE BUILDING,OR WORK
SEPTIC TANK SEEP PIT(S)
ADDRESS _ _ _ _ _ _ _ --- _ _ _ - _ r AND/OR DRAINFIELD
I HEREBY ACKNOWL GE THAT 1 HAVE READ THIS APPLI CESSPOOL(] DRYWELL
CATION AND STATE THAT THE ABOVE 18 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 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 I AM THE LEGAL OWN
ER OF THE ABOVE DESC ED R IDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE SEEP PIT(S)0 CESSPOOLS 4 d
OF PERMITTEE _ &i�-
_ _
76A642A 668 7/53