HomeMy Public PortalAbout10249 NADINE ST_Sewer__ DEe6ST3KNT OF COUNTY ENGMEEB SEWER—SEWAGE DISPOSAL 10-0131
DIVISION OF BUnMING AND SAFETY I PERMIT APPLICATION
COUNW OF LOS ANGELES
ILDING
WILLIAM J FOX, COUNTY ENGINEER ADDRESS /d
v FOR APPLIC NT TO RLL IN LOCALITY
BUILDING NEAREST a_ Q
ADDRESS CROSS ST `Lo -2�„
LOCALITY • DISTRACT NO SERIAL NO /� PERMIT NO
CRABS 8T f '"� A Q 3 '� S
REC IVED Y Ready for Inspostion DATE ISSUED
OWNER J
MAIL USE ZONE OCCUPANCY
ADDRESS / BK MAP PG
I
CITY TEL NO A - 1
CONTRACTOR C811forn3.a Sewer Const.('.e_ CO IMP NO
ADDRESS 1317 Colegrove Ave. JOB NO
CITY Montebello TEL NOUNJon 1-5048 TRUNK PERMIT NO �^
104445 STATE —
REGISTRATION NO q S ti@p r ROAD PERMIT NO
DESCRIPTION LOT NO I G7 D STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT�� WASTE APPROVAL
812E OF LOT,S`te K/a,0 NOW ON LOTS I CHARGES
USE OF
BUILDINGS CONNECTION CHA GE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER f $ S 00 RECEIPT NO ATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEP 10 ECORDED
WORK TO HOUSE SEWER 100 NO DA BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA.
SEPTIC TANK SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 200 STATION /�dSL 5 DEPTH (�
CESSPOOL—DRYWELL / MANHOLE REFERENCE
SPECIAL CONDITIONS ONLY 200 G S �/ I,// S PPER Vy � LOWER
TYPE OF CONNECTIO LGTH FROM
OWNERS PERMIT ; 1 00 - cuRe- c M LENTO P L .2 7
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESC IBED EXISTING APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIStQ DAY OF _ _ __I NEW HOUSE SEWER .S�G/I YO G ��G- 3
OWNER OR �� CONNECT ADDITIONAL
OWNERS AGEN�/T,4 0 A /. _ BUILDING OR WORK
ADDRESS /0A# _/� /
SEPTIC TANK
DRAINFIELD IT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI CESSPOOL[3 DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT r NO AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWER$ SEWAGE DISPOSA16 SYSTEM
I HEREBY CERTIFY THATRI A PROPERLY REGISTERED DISCONNECT PLUG AND
AND 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 DESCRI ED R IDENTIAL PROPERTY BACKFILLSEPTIC TAN PTICTAN
SIGNATURE SEEP PITS)[3 CESSPOOLS
OF PERMITTEE ' _
70A042D 00S 1/53 /�