HomeMy Public PortalAbout10680 ARROWOOD ST_Sewer__connect house sewer DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
.DIV?SION OF BUILDING AND SAFETY PERMIT APPLICATION 1
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILNG
ADDRDIESS_ 10 C.-'I
FOR APP A T TO FILL W -'� '� LOCALITY
ADDRESS �� J (i`� ����f BUILDING NEARES
✓ '✓Z �f c g' CROSS ST. cam, �.
LOCALITY DISTRICT N0. SERIAL NO. PERMIT N0.
NEAREST A ` qC� �S
CROSS ST.
RECEIVED BY Ready for Inspection DATEISSUED
OWNER Via
MAIL USE ZONE-I OCCUPANCY MAP
ADDRESS BK PG
CITYAf
TEL.NO. t\
CONTRACTOR t�c13 a 1
CO.IMP.N0.
ADDRESS
JOB.NO.
- TRUNK PERMIT N0. •
` / STATE
REGISTRATION NO. y7/ C Y �j COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT 2�� ��� INDUSTRIAL
WASTE APPROVAL .�
SIZE OF LOT NO.OF BLDGS.
1�3NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECT
IO ARG E FEE
NO. DESCRIPTION O WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT N0. DAT BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
ICONNECT ADDITIONAL BLDG.OR �f- EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0. I DATE I BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_
AND/OR DISPOSAL SYSTEM_ 1.00 �-t_ CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT_OR -
_ PITS AND/OR DRAINFIELD 2.00 I STATIONi �EPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MAFIHOLE REFERENCES-a��`,
UPPER LOWER
TYP-E=OF CONNECTION LENGTH FROM
Y.
OWNERS PERMIT ; CURB P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE Z I OC� (,L\.r k 1 e'ham+. C ��)1`'-
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____7............DAY OF--r9 -•....-•._....---1944 _ EW HOUSE SEWER
OWNER OR � CONNECT ADDITIONAL
OWNERS AGENT. - f��� � BUILDING OR WORKS
tom- �-d� --f--f•f- `� SEPTIC TANK,SEEP.PIT(S)
ADDRESS.._.: .-�.L.V1lArdlR�--_ a�. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL
CA
TIONAND 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/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPER BACKFILL SEPTIC TANKS I]
SIGNATURE / ,,,_ � SEEP.PIT(S)C] CESSPOOLS
OF PERMITTE - Lv4G6 - �.-
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