HomeMy Public PortalAbout10709 ARROWOOD ST_Sewer_4/1/1953_5335-32S sewer connection DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
1 WILLIAM J. FOX, COUNTY ENGINEER BUILDING J� Q g
ADDRESS /02/, !
FOR APPLICANT TO FILL IN LOCALITYBUILDING EAREST
ADDRESS 10709 ArroWood ,Ste CROSS ST.
LOCALITY �p1 DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST A Sf, 1'-
CROSS ST. El Monte A06 e r �
REPf IVED BY Ready for Inspection DATE ISSUED
OWNER. P.L. 1Ylc utt � - �"/ "'�ly
MAIL
ADDRESS 2721 San Gabriel Blvd, UCH ZONE OCCUPANCY BK MAP PG
CITY San GabrielTEL.NO. . AT 94364 0==---
CONTRACTORy�D'; & M. ConBtrnetion Can_ CO.IMP.NO.
ADDRESS 408 Winthrop Dre JOB NO.
CITY Alhambra TEL.NO. AT 48315 TRUNK PERMIT N0.
�J STATE
REGISTRATION NO. 113613 C 42 ❑ COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO-32 PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS. 2
USE OF p ,,,
NOW ON LOT .�� CHARGES„
BUILDINGS 1 Its CONNECTION CHARGE FEE �r y
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE .
PUBLIC SEWER @ $ 3.50 RECEIPT
CEIPT NO. DA E I BY
HOUSE SEWER CONNECTING TO =i
_ PWVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR / EXCEPT3R
OR R E
ECORDED
WORK TO HOUSE-SEWER' 1.00 t
ON
ALTER REPAIXISTING t NO--.,I DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR �p
PITS AND/OR DRAINFIELD 2.00 STATIONDEPTH �l®
CESSPOOL—DRY W ELL <
SPECIAL CONDITIONS ONLY 2.00 � �► F-- MA1IHOLE REFERENCE
1.,QYY
42-06-UPPER EW
� �
STYPE OF CO-6 C�N LENGTH F
OWNERS PERMIT $ 1 00 '' ,�t}RB P.L. d�' M.yh
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC .SEWER
SIGNED THIS----------------- -DAY OF---------------------...................19......_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..........................-.................................................... BUILDING OR WOR K
ADDRESS---------------------------------_------- -- SEPTIC TANK.SEEP.PIT(S)
- - - - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL E] 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
DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBE RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP.PIT(S)o CESSPOOLS 0
OFME
PERMITTEE� f%°� � �,�nr
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