HomeMy Public PortalAbout10720 ARROWOOD ST_Sewer__ IDEPAItaMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I AUILDING DDRESS �� �lj✓��O�ta� � '
FOR APPLICANT TO .FILL IN LOCALITY / ffff�
BUILDING NEAREST
ADDRESS' 10720 ArroWood St. CROSS ST. ,6" e- me—
LOCALITY 131 Monte DISTRICT NO. SERIAL NO. PERMIT NO.
NEARESTI;l Monte Aeee '510 5
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUQED_gg
OWNER P.Lo I aM:itt e —..� ��_j:3
ADDRESS MAIL 272'x• San Gabriel Bled. US ZONE OCCUPANCY BK MAP PG
CITY San Gabriel.rEL.NO.AT 94364 44 I -
CONTRACTOR Ia T) & TOT Conatrr�ot 9 on C�
• • e o CO.IMP.NO.
ADDRESS 408 Winthrop I)r. JOB NO.
CITY Alhambra TEL.NO. At 48315 TRUNK PERMIT N0. -
REGISTRATION NO. 113613 Q 42 ❑ COUNTY.
ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NQ. 39 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
N0.OF BLDGS. •��
SIZE OF LOT NOW ON LOT 2 'CHARGES
USE OF
BUILDINGS 1 Ree o CONNECTION CHARGE FEE i
NO. DESCRIPTION OF WORK FEE i
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE, I BY
HOUSESEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 /
CONNECT ADDITIONAL BLDG.OR !• EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO DATE N BY
SEWER OR DISPOSAL SYSTEM 1.001 �I� f
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR �ry
PITS AND/OR DRAINFIELD 2.00 STATION V DEPTH o
CESSPOOL—D RYW ELL
SPECIAL CONDITIONS ONLY 2.00 _/q ® � A HOLE REFERENCE
UPPER E0-V1EER
� TYP -0F CONNECTION L� LENGTH FROM=
OWNERS PERMIT $ I 00 Ct�rR6— P.L. W TOFP t".___ _
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED'
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS--•-_._._------_-.-DAY OF........................................I9•.-__- NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...........................-..............-..........................-......... BUILDING OR WORK
ADDRESS-----------------------_------_--------.----------- SEPTlC TANK.SEEP.PITS)
- - - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL DRYWELL
CAT
NON 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 I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE S EWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RES)IIEN_TILJkL PROPERTY. BACKFILL SEPTIC TANKS El
SEEP.PIT(S)� CESSPOOLS E]
SIGNATURE
j�� tic E%
OF PERMITTEE-6f /�_---------------_.� -.T--f�--- - �•_.-._.
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