HomeMy Public PortalAbout10703 ARROWOOD ST_Sewer_4/1/1950_sewer connection )TDEPAU'VV1ENT 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
FOR APPLICANT TO FILL IN LOCALITY
BUILDING ADDRESS 10703 Arrewood St o CROSS ST. 0/'w
LOCALITY manteDISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST
CROSS ST. I M(7ritA Ave ; RECEIV D BY Ready for Inspection DATEISSUED
OWNER Po L. MnNutt
MAIL —ZONE 2722 San Gabriel Bledo USE NE OCCUPANCY MAP PG
CITY San Gabriel TEL.NO. T I B
CONTRACTOR M. ari on OQ CtractiC
lio Ra BC o S CO.IMP.N0.
ADDRESS 408 Ninthrop Dro JOB NO.
CITY Alhambra TELAO. AT 48315 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 333633 171 42 ❑ COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. l STATE ENCROACHMENT f
'� PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE CF LOT N0.Br BL
NOW ON LOT
l 'CHARGES
USE
BUI DINGS j? CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEEPUBLI
HOUSE EWER @ $ 3.50 I E`
REC T NO. DA'',E BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO DATEfR6_Y
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 DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 10 �M�1 UUP-PLE R�E�FEREf "d /E/
WER
TYPE OF CONNECTION Lis-•' LENGTF�FaR09''
OWNERS PERMIT $ I 00 Y.�- P_UBs P.L. M.I-:�O P_L
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'SSIGNATURE DATE
. -
SIGNED THIS--------------------DAY OF------_....---.•-------------_-----•-•-19_----•- NEW HOUSE SEWER l'3A
OWNER OR CONNECT ADDITIONAL / <r
OWNERS AGENT......................................................- • . BUILDING OR WORK
--------------------------------. ----_ -- SEPTIC TANK,SEEP.PITS)
ADDRESS----
----------------------------------------...-- AND/O R D R A I N F I E L D
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] DRYWELL E]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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
,,,�� SEEP.PIT(S)[] CESSPOOLS
SIGNATURE ���� -��� ��
OF PERMITTEE���.--�=•--------- -----�`-''°'-�•--------------- "---- I
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