HomeMy Public PortalAbout10721 ARROWOOD ST_Sewer__ DEP"rMENT OF COUNTY ENGINEER p. SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES -
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS 7,2 A-Yo w.oWSIf
f FOR APPLICANT TO FILL IN LOCALITY
BUILDING /J
13 ADDRESS 1071'.Arrow0od St. NEARESTCROSS ST.
LOCALITY Fl Monte DISTRI T NO. p SERIAL NO.
PERMIT NO.
NEAREST sf !y5 ��
CROSS ST. �1 �ojato -U0, F
R—ECCEIEIVED BY Ready for inspection DATEISSUED
OWNER P.L. M-Nutt
MAIL
ADDRESS 272 San Gabriel Blvd. US ZONE OCCUPANCY BK MAP PG
CITY San Gabri.elTEL.No.At 94364 – OR
CONTRACTOR L.1). & MA Construction On- CO.IMP.NO.
ADDRESS 408 Winthrop Dr.
Alhambra AT 48315 boa No.
CITY TEL.NO. TRUNK PERMI-T NO.
REGISTRATION NO. ZZ?61? C 42 El COUNTY
ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. ' STATE ENCROACHMENT y
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT 2 CHARGES
USE OF
BUILDINGS 1 R®So CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE ry
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLIC SEWER @ $ 3.50 ✓ RECEIPT NO.s''_ DATE I BY
HOUSE SEWER CONNECTING TO ?-
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OREXCEPTION RECORDED!
WORK TO HOUSE SEWER - 1.00 E
ALTER OR REPAIR EXISTING NO. �GDATE I BY
SEWER OR DISPOSAL SYSTEM 1.00 s
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE,PIT OR _ -
_PITSAND/ORDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—D RY W ELL
SPECIAL CONDITIONS ONLY 2.00 e y�D wMANHOLE LOWER
41-
TYPE OF CONN,ECTION LENGTH F 0
2 V--sem"' CURB' P.L. lr� j'I:l TO
OWNERS- PERMIT $ 1 00
AUTHORIZATION'' TOTAL TOTAL FEE _1 adas iT ,
1 HAVE THIS DATE CON ACTED WITH THE HEREIN NAMED
HAVE
TO CONNECTa THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIR SEWER
APPROVALS INSPECTOR'S SIGNATURE DATE
.
SIGNED THIS--------------------DAY OF.................................. I9.______. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT---:_ ........................................................-__••_ BUILDING OR WORK
- A �� SEPTIC TANK,SEEP.PIT(S)
ADDRESS........-------------- �y - ...----------..._.._- AND/OR DRAINFIELD
1 HEREBY A' NOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL
CATION AND STATE THATIT;HE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. ISEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT IAM 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 PROP RTY., BACKFILL SEPTIC TANKS E)
SIGNATUREf ' SEEP.PIT(S)[-] CESSPOOLS
OF PERMITTEE-°�A-!/. : V'2•F---
76A642D 663 1/53