HomeMy Public PortalAbout10648 ARROWOOD ST_Sewer_4/16/1954_23925 house sewer connecting to public sewer ]DEPARTMENT OF COUNTY ENGIINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS
FOR APPLICANT TO FILL IN / LOCALITYBUILDING
NEAREST
ADDRESS (� �J 4/ -A-" �/'7�/XW/ CROSS ST.
LOCALITY
)� DISTRICTNO. SERIAL NO. PERMIT NO.
(�
NEAREST V 7/ j A 3
CROSS ST. � � � �r!d'C// n Y REE I`VT VEEDaBY Ready for Inspection D ISSUE 11
OWNERMAIL
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ADDRESS ` v USE-ZO�% OCCUPANCY =a=
SK PG
CITYg TEL.NO. � G J
CONTRACTOR / `•,y /4,1)4 4 CO.IMP.NO. 13211
ADDRESS (, ^� li B NO.
CITY TEL.NO. 67I Q TRUNK PERMIT NO.
61 STATE
REGISTRATION NO. d e? 2,e/�� -7 g COUNTY ROAD PERMIT NO.
LEGAL /� / /y� STATE ENCROACHMENT
DESCRIPTION LOT N0. l 77 V� l _ PERMIT NO.
BLOCK TRACTf INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT 7d x\/ N0.OF BLDGS. / /
NOW ON LOT CHARGES
USE OF /�/ /
BUILDINGS a CONNECTION CHARGE FE
NO. DESCRIPTIiON OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 =7K!' RECEIPT NO. I ATE I BY
HOUSE SEWER CONNECTING TO f
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION R CORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING N0. I DATI BY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR y
PITS AND/OR DRAINFIELD 2.00 STATION / / S DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / ,�� MANHHOOLREFERENCE ta LOWER
.' TYPE 0 ECTION LENGTH FROM �®
OWNERS PERMIT $ 1 00 CURB M.L.TO P.L. y7
AUTHORIZATION I TOTAL FEE —� 3�
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED i
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLISIGNEDNTHIS.IG TO EuB,/DAY OFLIC ERj.�__` �"!__JI9.. �a NEW HOUSE SEWER �� d��
OWNER OR /'►�� CONNECT ADDITIONAL
OWNERS AGENT-_-____fes_••_- B BUILDING OR WORK
c-...---- ...._ -..._..._.. -......._
ADDRESS_________________ SEPTIC TANK,SEEP.PIT(S)
- - -••----------•--•-------- .-••---••------------ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL I] 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
ANO/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. BACKFILL SEPTIC TANKS
V
SEEP.PIT(S)� CESSPOOLS
SIGNATUREOF PERMITTE . JS'
_ .---._----__.-._ ...._..._._.....
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