HomeMy Public PortalAbout10668 ARROWOOD ST_Sewer_10/16/1956_house sewer connection to public sewer ._ 6420 F®R PERMIT
9 8 E-66 9-53 APPLICATIONDIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles B D sG
WM.J. FOX, COUNTY ENGINEER
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY rG ' pi-
FOR APPLICANT TO FILL IN NEAREST
CROSS ST.
LEGAL ,.,- Ni"'E CRIPTIONr�,aLVOT D.` ® - — 5c OWNER P i C NA Aa 0 , NGty 0651?5eA/
BLOCK - TRACT ADDRESS MAIL SA ME, Y -
y NO. OF SLOGS. Q
SIZE OF LOT / NOW ON LOT ata CITY TEL. NO.
USE OF /7ieA�' L 4 IN
/'I.
BUILDINGS r✓✓E� z C! F:-
O. .I GROUP i MAP
BK PG
CONTRACTOR
ADDRESS
MARTIN .KORDI-g- CONNECTION DATA
w,
CITY ARCADIA}. ,�[TA AVE. DEPTH '�q
Tat71i
Ea STATEERENCE -LOWER
REGISTRATION NO. (9 ��� ❑ COUNTY
NO. DESCRIPTION OF WORK FEE y
HOUSE SEWER CONNECTING TO t�J1� RBNNECTIOP L, LENGTH P.L.
TH OM y �,
PUBLIC SEWER a $ 3.50 (� V
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 _
CONNECT ADDITIONAL BLDG. OR M - P. C. NO.
I -
WORK TO HOUSE SEWER 1.00 ` !/ CO. MP. NO. �.f JOB NO.
lr
-_ALTER OR REPAIR EXISTING _ TRUNK PERMIT NO. ROAD PERMIT NO. �,�J� �Y
SEWER OR DISPOSAL SYSTEM 1.00 ,r u K
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL'SYSTEM 1.00 PERMIT NO, \
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL -
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
5 1 00
PERMIT CONNECTION CHARGE FEE
ER'
OWNS
AUTHORISATION TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVE TTOS CONNECT THE DATE ABOVECTED WDESCRIBEDITH THE H EX STINGEREIN A IDWELLIING ED CON- APPROVALS DATE - INSPECTOR*S SIGNATURE
TO THE PUBLIC SEWER -- - -
SIGNED THIS~ Y OF ) NEW HOUSE SEWER
OWNER OR
n CONNECT ADDITIONAL
OWNERS AGENT � �, -.-� BUILDING OR WORK -
SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1'HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ -
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. -
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER.
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP. PIT(S) ❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE -
19
WILLIAM J.FOX,COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF PLBG. INSPECTOR
1 [Ar, 1 4 0 2, OCT 16 4
5.5.Q '° .