HomeMy Public PortalAbout10727 ARROWOOD ST_Sewer__ IDEPAIVVMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
! COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER [BUILDING ADDRESS A07Z7 LOCALITY AreAwaadS14-
FOR APPLICANT TO FILL IN
NEAREST
ADDRESS S 10727 Arrowc�od Ste CROSS ST.
ADDRESS
LOCALITY El Monte DISTRICT NO. SERIAL NO. PERMIT NO. c
CNEAREST ROSS ST. EZ Monte gye o ���� A � �� �� ��ff�S
RECEIVED BY Ready tar Inspection DATE ISSUED
OWNER RL, McNutt
MAIL
ADDRESS 272+2 San Gabriel Blvdo USL✓ZONE OCCUPANCY MAP
BK PG
CITY San Gabriel TEL.NO. AT 94364 I
CONTRACTOR � .PNS 0mm At=,�j8n GOD
bio— CO.IMP.NO.. 1 �
ADDRESS 408 Winthrop Dro X06 No. A- o
CITY Alhambra TEL.NO. AT48 15 TRUNK PERMIT.NO.STATE
7`
REGISTRATION NO. 113613 C 42 COUNTY ROAD PERMIT NO.�
LEGAL
DESCRIPTION LOT N0. 35 STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.BF BL
NOW ON LOT
1 CHARGES
USOF
BUILDINGS 1 RASO CONNECTION CHARGE FEES`
NO. DESCRIPTION OF WORK FEE `l N
HOUSE SEWER CONNECTING TO REIMBURSEMENT..FEEi� p
l PUBLIC SEWER 0 $ 3.50RECEI.PT-NO. �� DATE_';� �BY
HOUSE SEWER CONNECTING TOf
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR XCEPTION RECORDED
WORK TO_HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING / NU• 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
PITS AND/OR DRAINFIELD 2.00 c� G9
CESSPOOL—DRYWELL STATION J/ /� DEPTH
SPECIAL CONDITIONS ONLY 2.00 `G A.A M 14H0LE REFERENCE
� 9¢1 1�,oi UPPERa e_;iz LOWER
TYgE OF CONNECTION LENGTH F 61-�
OWNERS PERMIT $ I 00 sYa9 CU.RB�_ P.L. &L.:TOIL.
AUTHORIZATION TOTAL FEE
1 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 y3f
i. '
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.............................................................................. BUILDING OR WORK
ADDRESS.......................-- SEPTIC TANK,SEEP.PIT(S)
-._.........- AND/ORDRAINFIELD
i
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL 0 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG, ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESLDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
i
SIGNATURE
ll 1 SEEP.PIT(S)� S
CESSPOOL
OF PERMITTEE- -4.r�-/'
76A642D 663 1/53