HomeMy Public PortalAbout10733 ARROWOOD ST_Sewer__ DEPAatrmtENT OF COUNTY ENGINEER j SEWER-SEWAGE DISPOSALDIVISION OF BUILDING AND SAFETY � PERMIT APPLICATION
COUNT' OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILNG
I ADDRDIESS �� � � kj'�0'0 14®a����'
E.�
FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 3 0)733 A rrowood St- 1, CROSS ST.
N d F —mak
LOCALITY $1 Monte DISTRICT NO. SERIAL NO. PERMIT NO. c
NEAREST c` A S
�� ���� �
CROSS ST. El Monte tyeu
RECEtVE1VBY Ready for Inspection DATE ISSUED
OWNER P° Lo McNuttMAIL
� L
ADDRESS 2722 San Gabriel Blvd° �US—E pNE OCCUPANCY MAP
f� I I BK PG
CITY ren GabrielTEL.No. AT 94364
CONTRACTORL, Do & Mo Construction Coo
CO.IMP.N0.
ADDRESS 408 Winthrop Dro JOB No.
CITY Alhambra TEL.No AT 48315
TRUNK PERMIT N0.
REGISTRATION NO. 113613 0 42 X STATE
❑ COUNTY ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT N0. 36 PERM.IT NOROACHMENT
BLOCK TRACT 17867 INDUSTRIAL
WASTE APP OVAL
SIZE OF LOT N0.OF BLDGS.
NOW ON LOT �+ 0CH`ARGES
USE OF � ,r^
BUILDINGS 1 ReSo CONNECTIONCHARGEFFEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE S _0
1 PUBLICSEWER @ $ 3.50
HOUSE SEWER CONNECTING TO RECEIPT NO. I DATE ]`B�
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCE,PTION RECORDEDa
WORK TO HOUSE SEWER 1_00
ALTEF'ORFREPAIR EXISTING "o•. r DATE BY
SEWER OR DISPOSAL SYSTEM A.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM LOO CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION7,4DEPTH
CESSOSPECIALCONDITIONS ONLY 2.00 MANHOLE REFERENCE
Q��� 9e cUECER3f LOWER
TYPE OF CONNEp TIONLENGTH FROM
OWNERS PERMIT $ I 00 c�R P.L.:;/4� M_L.eTO=P
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 4
OWNERS AGENT............................................................................. BUILDING OR WORK
ADDRESS..............-------------------------------- SEPTIC TANK,SEEP.PIT(S)
- ........ AND/OR DRAINFIELD
I 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
1HEREBY 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 RESIDENTIAL PROPERTY. BACKFI LL SEPTIC TANKS
SIGNATURE l// 3f� � / SEEP.PIT(S)❑ CESSPOOLS
OF PERMITTEE-- - ------'�i �sG?1- .................... -----•.
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