HomeMy Public PortalAbout10662 ARROWOOD ST_Sewer_1/6/1955_house sewer connection to public sewer DEPARTMENT OF COUNTY ENGlNEFM SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES 1
WILLIAM J. FOX, COUNTY ENGINEER ! BUILDING
ADDRESS /0(6
f C (
FOR APPLICANT TO FILL IN LOCALITY �, �/�, , All
BUILDINGA NEAREST
ADDRESS /®� �j � �O�p�U to CROSS ST.
LOCALITY g� �� �� DISTRICT N0. SERIAL NO. PERMIT NO.
p j �i + Cr Q S
NEAREST �
CROSS ST. RECEIVE BY Ready for Inspection A E ISSUED
OWNER Z57-rej�aI
MAIL f USE ZONE OCCUPANCYBK MAP PG
ADDRESS �` `C_
CITY TEL.NO. S-04 O '?1—, S A L, - gam
CONTRACTOR Al=�, ` CO.IMP.NO.
ADDRESS o� `� GAG. � n C_nL�. `cwt`/." JOB.NO. -
CITY _5 � � TEL.NO.Ar. 0077 TRUNK PERMIT NO.
STATE '
REGISTRATION NO. `J� �— ® COUNTY ROAD PERMIT NO. _
LEGAL
DESCRIPTION LOT NO. STATE
ARMJJT NO.
ROACHMENT
BLOCK TRACT ` 2 Z O S� INDUSTR
WASTE APP VAL
SIZE OF LOT �^ Z� N0.OF BLDGS.
NOW ON LOT CHARGES
7 I
USE OF [ �6�6
BUILDINGS J CONNECTION CHARGE F
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO v
PUBLIC SEWER @ $ 3.50 3 Sd RECEIPT NO_,10'p I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 y
ALTER OR REPAIR EXISTING NO. 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 Z f--I?j DEPTH G
CESSPOOL—DRYWELL
_SPECIAL CONDITIONS ONLY 2.00 3 J® MANHOLLERREFERENCE
Jay"
SLOWER
TYPE OFC/0N41ECTION LENGTH FROM ®0
Yr CURB s8.'J:. M.L.TO P.L. aJ
OWNERS PERMIT $ I 1 00
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE, CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DES RIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....................DAY OF..........I __.�___�___.___ ° NEW HOUSE SEWER - i
OWNER OR r� CONNECT ADDITIONAL
.._. y�°i ' BUILDING OR WORK
OWNERS AGENTK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS--........------------_--------------..._------- _-................................. AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[-] DRYWELL
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 1 AM PROPERLY REGISTERED AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL P�ERTY. BACKFILL SEPTIC TANKS Ej
SIGNATURE y¢' SEEP.PIT(S)� CESSPOOLS
OF Pll
ERMITTEE.-----.CA----------�- ��.-8--
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