HomeMy Public PortalAbout10841 ARROWOOD ST_Sewer__ DEPARTMENT OF COUNTY ENGtINF.ER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATlONI
COUNTY OF LOS ANGELES j }
WILLIAM J. FOX, COUNTY ENo1NEeR 1 ` I AADDRESS. 974—
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FORQAPPLIC T TO FILL IN LOCALITYBUILDING J� `�j �•,,��
NEAREST
ADDRESS DSGI 42QZ D u/a o D CROSS ST. ��/ /j ;�, �, .0 AAA
LOCALITY DISTRIC, NO. Ready f6 Inspection PERMIT NO. C
NEAREST Q I 139� 267 J
CROSS ST. RECEIVED BY DATE ISS�U D BY DATE
OWNER ,v. C��m .JSC1✓ r? '✓`..t�' �Z-.& I ,cam �ll /E�z -154
MAIL
AD RESS I I I Q �_C— 2. -(jy i USE Z�0 E OCCUPANCY BK MAP PG
CITYt7 TELAO.
CONTRACTOR { ✓ .` I SILQU lcl"lto O�
CO.IMP.N0.
ADDRESS
JOB NO.
CITY _7 ./���yqj TEL.N0. 9 9?e4�GJ TRUNK PERMIT N0.
REGISTRATION NO. / 4 7 STATE
ROAD PERMIT NO.,
LEGAL -
DESCRIPTION LOT NO. 3 s STATET NCROACHMENT
PERMIBLOCK TRACT I ® INDU_ TRIAL
WASTE APPROVAL
SIZE OF LOT � NO.OF BLDGS.
_+V X 'U NOW ON LOT CHARGES
USE OF ���
BUILDINGS G� y p ,� ,� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOy REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 7RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO //
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLD6.OR EXCEPTION RECORDED
_ WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- DATE I 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 STATION DEPTH
CESSPOOL—DRYWELL ^'
_SPECIAL CONDITIONS ONLY 2.00 qqr� r MANHOL�RR�FERENCE
�CF4 J
"e14 �`UPPER�J_ ', WER-
Y TYPE UDRBECTION P.L.
"EL TO P.�FROM �y
OWNERS PERMIT ; 1 00
AUTHORIZATION 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__Z____ AY OF_.__ 19� NEW HOUSE SEWER
OWNER OR , ` 1CONNECT ADDITIONAL
OWNERS AGENT___ _ BUILDING OR WORK
ADDRESS.__._ SEPTIC TANK,SEEP.PIT(S)
�� - - - - - -- - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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
1 HEREBY CERTIFY THAT I AM PROPERLY RE ISTERED
AND/OR LICENSED AS REQUIRED BY ANGE COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT M TH AL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RES TIAL R ERTY. BACKFILL SEPTIC TANKS o
SIGNATOR SEEP.PIT(S)E] CESSPOOLS
OF PERMI TEE_____ —__
76A642D S&E 54