HomeMy Public PortalAbout10714 ARROWOOD ST_Sewer__ IDEPARTMIENT OF COUNTY ENGINEER SEWERmSEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX; COUNTY ENGINEER BUILDING
I ADDRESS
FOR APPLICANT TO FILL IN LOCALITYBUILDING
ADDRESS 10714 Arrowood St. CROSS ST. a r
LOCALITY El Dont® DISTRICT NO. SERIAL NO. PERMIT NO.
{ NEAREST
CROSS ST. El D!tOnt® gV6 o RECEIVED BY Ready for Inspection DATE ISSUED
OWNER PoL. Me-Nutt �<� �-
MAIL US ZONE OCCUPANCY MAP
ADDRESS 2 San Ga-bx!i Al p1�e BK PG
CITY San.Gabriel TEL—NO—AT 94364
CONTRACTORL.,D. & Al. COnStruotion Con CO.IMP.NO.
ADDRESS 408 Winthrop Dro
JOB N0.
CITY Albambra TEL.NO. AT 48315
TRUNK PERMIT N0.
REGISTRATI0312N3613 C 42STATE
LEGAL
COUNTY ROAD PERMIT NO.DESCRIPTION LOT NO. 40 STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT 17867 INDUSTRIAL
N S APPROVAL
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT 1 CHARGESi' ,
USE OF \>=rJ
BUILDINGS Z RGi�B CONNECTION CHARGE FEE �\
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEES {�
PUBLICSEWER @ $ 3.50 RECEIPT NO'.-�z' DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR .0" EXCEPTION RECORDED"
WORK TO HOUSE SEWER 1.00
—ALTER OR REPAIR EXISTING f 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 STATION � � DEPTH �i�0
PITS AND/OR DRAINFIELD 2.00
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ZOA ® ap� .- MANHOLE REFERENCE
q" _�q f UPPER =�L'OWER
TYPE OF CONNECTION LENGTH_F.ROM
OWNERS PERMIT $ I 00 Y cua� P.L. Wj!� ;P:L.
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 �Q,,�//%�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT----------------------------------------------••------_---------------------- BUILDING OR WORK
ADDRESS------------------------------------------------------------------_----- - SEPTIC TANK,SEEP.PIT(S)
• •••••--•• AND/OR DRAINFIELD
1 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
1 HEREBY 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 I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED R.F51DENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]
SEEP.PIT(S)E] CESSPOOLS
SIGNATURE 'i __ � �' f ji
OF PERMITTEE_. __-____
76A642D 663 1/53 r