HomeMy Public PortalAbout10657 ARROWOOD ST_Sewer_12/2/1954_house sewer connection to public sewer DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL.
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS V/�((P /7� ,r,17 �]"h�
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FOR APPLICANT TO FILL IN LOCALITY 7-0/4104,60c' Cl-,i
BUILDING n /Q NEAREST
ADDRESS AO4.S 7 (//1/l./ic�wla CROSS ST. � �-
LOCALITY O./�,cnf�7 'O!�k�ti DISTRICT NO. SERIAL N0. FE3RpM.IT N0.
NEAREST /J v A �'vy � s
CROSS•ST. /a �/�f��?
"—� RECEIVED BY Ready for Inspection DATEISSUED
OWNER .0 �/;E-;L -✓-y
MAIL U�SEQZONE I OCCUPANCY MAP
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CITY TELNO. Z
CONTRACTOR ��, �' �"� $'�/� CO.IMP.NO.Of
ADDRESS JOB.NO.
CITY✓� ��� �� TEL.NO.Ar. TRUNK PERMIT NO.
� A ❑❑ STATE ��O
REGISTRATION N0. ��'� -��� �• F_ O COUNTY ROAD PERMIT N0. t
LEGAL yy- STATE ENCROACHMENT;
DESCRIPTION LOT NO. o�� PERMIT NO.
BLOCK TRACT �y9, INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOGS. ® CHARGES
NOW ON LOT
USE OF _ �-
BUILDINGS ' 4�✓� �✓ CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 d RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO.
ALTER OR REPAIR EXISTING DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION 4 &1 DEPTH
CESSPOOLDRYWELL L/� r MA UPPEgREFERENCE � £R
SPECIAL CONDITIONS ONLY 2.00 7' �7
TYPE OF CONNECTION LENGTH FROM �/
Y. 6U�R$-- '� M.L.TO P.L.
OWNERS PERMIT ::l=1 00
AUTHORIZATION I TOTAL FEE 1 f4 s"0 ED �1ff/ r /��
CONTRACTOHAVE IR TO CONNECT THS DATE TE ABOVE D SCRIBEDED WITH THE IEXISTING APPROVALS INSPQCTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER �•,�
SIGNED THIS__...._..-__.DAY-OF__. ✓_._�_ __19s:! NEW HOUSE SEWER
OWNER OR DAY-OF_
CONNECT ADDITIONAL
w BUILDING OR WORK
OWNERS AGENT...........`-`---._..._-•---.....----.._...-----•--•-•-------.�._
SEPTIC TANK,SEEP.PIT(S)
ADDRESS...............-......_...__._.......---.......__..._...__...._..........-._-......_... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL I]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 THAT I AM PROPERLY REGISTER..
R PLUG AND
DISCONNECT
AND/OLICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUG AND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
s,` e SEEP.PIT(S)[] CESSPOOLS
�s V
OF PERMITTEE--- �
1
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