HomeMy Public PortalAbout10676 ARROWOOD ST_Sewer_8/21/1953_connect house sewer DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICA T TO FILL IN / /! LOC�LLITY
BUILDING/ / 71� ( l/,. NEAREST �7
ADORE (�(A� /(w Z j 3�- CROS8ST. / /��
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST / A c �j/lJ �C/ S
CROSS ST. �gl gy Ready for InaDeetlon DA7EISSUED�
OWNER
MAIL USE ZONE OCCUPANCY
ADDRESS cy��'
K P
CITY TEL.NO.
CONTRACTOR 8� ✓G-7 CO.IMP.NO.
ADDRESS L L )OB N0.
CITY TEL.NO. � � TRUNK PERMIT NO.
r /
41-Wr TE �7 —7
REGISTRATION N6' a. ❑ COUNTY ROAD PERMIT NO. F' -2-
LEGAL
DESCRIPTfON LOT NO../ STATE ENCROACHMENT
p PERMIT N0.
BLOCK TRACT 126- INDUSTRIAL
WASTE APPROVAL
:SIZE OF LOT NO.OFBLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGSCONNECTION CHARGE FE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 RECEIPT NO. I A E BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTIOYRE'GqRDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO I DATE 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 7L/Z.D DEPTH CGU
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ,��INAN PPER FER
_ _TYPE 07CURB�iE/CTION� LEN�H�M
OWNERS PERMIT $ 1 00 M.L.TO P.L. X �.
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....................DAY OF................-..--................19_.___ NEW HOUSE SEWER )T
OWNER OR - qq �L- .. CONNECT ADDITIONAL
OWNERS AGENTLI�J/. %G - -t... :./ L .S_�.!.. BUILDING OR WORK
ADDRESS .. ... - y
_ / SEPTIC TANK,SEEP.PIT(S)
�( --. AND/OR DRAINFIELD
CAITHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL I] DRYWELL E
ION 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 'PROPERLY REGIS DISCONNECT PLUG AND
AND/OR LICENSED AS RE ED BY,4LOS ANGELE OUNTY� A ANDON HOUSE SEWER
AND STATE OF CALIFOR AOR THAT I AM THE GAL OWN
ER OF THE ABOVE DRSCRIIJED SIDENTIAL P OPERT Y/ ACKFILL SEPTIC TANKS
EEP.PIT(S)E] CESSPOOLS
SIGNATURE
OFPERMITTEE-----------........................... - - .�� .......-•--.......
76A642D 663 1/53
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