HomeMy Public PortalAbout10243 NADINE ST_Sewer__ tDFPARTMENT OF COUNTY ENGINEER , SEWER-SEWAGE DISPOSAL 19171
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
!` COUNTY OF LOS ANGELES BUILDING n
WILLIAM J FOX. COUNTY ENGINEER JI ADDRESS 4 2 3
FOR APPLI T TO FILLIN LOCALITY Lam,
ADDRESS/D�4 , NEAREST C
CROSS ST
LOCALITY I
DISTRICT NO SERIAL NO PERMIT NO c
NEAREST 5 A / 0036 J
CROSS ST �E EIVE BY
Ready for Inspection DATE ISSUED
OWNER //`J /�— 3 ��3
MAIL USE ZONE ( OCCUPANCY BK MAP P8
ADDRESS
CITY TEL.NO
CONTRACTORCalif ornla .Sewer Consti.Coo CO IMP NO
ADDRESS 1317 Colegrove Ave. JOB NO
CITY Montebello TEL N4Mion 1-5048 TRUNK PERMIT NO
TE r---��
REGISTRATION NO 104"5 SL® TLIANTY ROAD PERMIT NO
LEGAL /`fes STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT �' p� INDUSTRIAL
VDUWASE APPROVAL —�-
SIZE OF LOT NO OF BLDG8 CHARGES
NOW ON LOT
USE OF CONNECTION CHA OE FEE
BUILDINGS
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FE
PUBLIC SEWER CONNECTING TO R ; 3 w RECEIPT NODAT BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPT ECORDED
WORK TO HOUSE SEWER 100 NO
ALTER OR REPAIR EXISTING DAT BY
SEWER OR DISPOSAL SYSTEM In
DISCONNECT
DISPOSAL SYSTEM SEWER 100 16ONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION 279-'L DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 , �� UPPEREFERENCE Cmm
TYPE OF CONN CTI LENGTH FROM /
OWNERS M L TOP L
PERMIT ; I 00
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTORSSIONATURE DATE
DWELLING TO.THEAIILI0 SEWER
SIGNED THIS ..DA OF_ 19� NEW NOOSE SEWER
OWNER OR ' CONNECT ADDITIONAL
OWNERS AGEN _ BUILDING OR WORK
ADDRESS 0°� � '��. _ AND%OR DRAINFIELDIT(8)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIN 4011.1 CESSPOOL[3 DRYWELL I]
CATION AND STATE THAT THE ABOVE 18 CORRECT AND REE
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 AN PROPERLY REGISTERED DISCONNECT PLUS AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN
ER OF THE ABOVE DESC BED DENTIAL PROPE BACKFILL SEPTIC TANK ❑
r1110HATURE SEEP PIT(S)[] CESSPOOLS -�S
OF PERMITTEE.iGL.I
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