HomeMy Public PortalAbout10828 ARROWOOD ST_Sewer__ 78A8420^ f/' PPU�JA II �®IlV FOR PER9VW Il� ..
CE808 8.59 '
COUNTY OF LOS ANGELES SEWER—SEWAGE D9SOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUDILDING
O
JOHN A. LAMBIE, County Engineer
ADRESS
CASSATT D. GRIFFIN, Sup t of Bu lag LOCALITY
- NEAREST "
FOR APPLICANTTQr FAIL IN CROSS ST.
LEGAL J "
DESCRIPTION LOT NO. - OWNER
BLOCK TRACT MAIL
ADDRESS
N0.0 BLDGS. -
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS r DISTRICT NO. GROUP MAP / PROCESSED-BY
CONTRACTOR I �� / JPS( I
LLLJJ7
'.' ADDRESS " CONNECTION DATA
w CITY 2 L.N0. ���I STATION f Q DEPTH
REGISTRATION NO. ✓ ❑ COUNTY MANHOLE REFERENCE v
NO. DESCRIPTION OF WORK FEE LOWER
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 1 3 1 ® a TYPE OF CONNECTI LENGTH FROM /
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L. T P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN..CESSPOOL.DRYWELL @ $2.00
HOUSE SEWER CONNECTING TOP.
C.N0.
PRIVATE DISPOSAL SYSTEM ' @ $1.00 �? CO.IMP. NO. (p _ JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT N0. ROAD PERMIT N0.
WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSALSYSTEM@,$1.00 PERMIT NO.
u. INDUSTRIAL f V ' >
✓ � 1' n -` _ ` WASTE APPROVAL
f � CHARGES
OWNER'S PERMIT $ 2 00 , CONNECTION CHARGE FEE
z AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- y,
TRACTOR TO CONNECT THE ABOVE'DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ M NEW HOUSE SEWER —/,j _-
!_ OWNER OR CONNECT ADDITIONAL
OWNERS AGENT' BUILDING OR WORK J ac1� t✓�1.«�____
ADDRESS SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
LDESCRIBED
EBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
TE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
LL COUNTY ORDINANCES AND STATE LAWS REGULATING "y ALTER,REPAIR,SEWER OR
G AND SEWERS. _ SEWAGE DISPOSAL SYSTEM
EBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
D AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - ABANDON HOUSE SEWER
NIA OR THAT 1 AM THE GAL OWN R OF THE ABOVE
ED RESIDEN�AL PRO ERTYBACKFILL SEPTIC TANKSRESEEP.PITS) ❑ CESSPOOLSMITTE - F" /
OF VALIDATION ROBERT A. WOOD
M.0. CASH SUPERVISING MECHANICAL ENGINEER
-&7 3 8 z! vd%R 8 1 0 A 6.0 0
DEPARTMENT OF COUNTY ENGINEER I SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING ARID SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES i
WILLIAM J. FCX, COUNTY ENGINEER BUILDING
ADDRESS "4tpe!)en,oe3
r
FORBUILDING APPLICANT TO FILL IN LOCALITY
ADDRESS �OQ 66j• NEAREST
/' CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT N0, c
NEAREST A '5 � C:) SF
CROSS ST. C
RECEIVED Ready for Inspection. D EIS rUED
OWNER �� �, J
MAIL tr / i USE PONE OCCUPANCY MAP
ADDRESS LL- I I BK PG
CITY ,. TEL.NO
11 or
CONTRACTOR t .,
CO.IMP.NO.
ADDRESS C•
JOB.N0.
CITY TEL.N it TRUNK PERMIT NO.
rySTATE
REGISTRATION N0. �U/ 7� COUNTY ROAD PERMIT N0.
LEGAL / STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT 1 ,102- 6 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF SLOGS. CHARGES
NOW ON LOT
.USE OFJ� CONNECTION CHARGE FEE
BUILDINGS /I
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $ 3.50 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
_PRiVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0.
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AID/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
1 SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I MANHOLE REFERENCEUPPERLOWER
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT I 1'[V
CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 17IHAVE THIS DATE CONTRACTED WITH THE HEREIN NAMEDCONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGAPPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE tyBLIC SEWER —ySIGNED THIS._.G_?7"— -DAY OF....... ....19.0,1 HOUSESEWER
NECT
,TOWNER OR I ' BUILDING OR WORKAL
OWNERS A//GE/MT-.� . L:,,&J��.47.. ry,��1`� -� SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
IHEREBY ACKNOWLEDGE THAT I HAVE READ HIS APP CESSPOOL[:] DRYWELL
CATION AND S7ATE THAT THE ABOVE IS CORRECT AND AGR E
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 SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE AB VEE DESCRIBED RESIDENT APEiiTY: BACKFILL SEPTIC TANKS
SIGNPgWE E /' ' SEEP.PIT(S)ECESSPOOLS
76A642 663 1/53 {