HomeMy Public PortalAbout10600 SPARKLETT ST_Sewer__ DE'PAICrDIEPrr OF OOIINTT ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUMDING AND SAFETY PERMIT APPLICATION
COUNW OF LOS ANGELES
WILLIAK. J FOX. COUNTY ENGINEER BUILDING TO / O
ADDRESS V
FOR APPLICANT TO FILL IN p
ADDRESS 10600 Sparklett St.
LOCALITY Temple City NIL SERIAL KD PERMIT NO
NEAREST $L MOIIte AGB• ACROSSl�S,l•If� ,_S
BY Ready Ir Ia.P..N.a DATE ISSUED
OWNERP.L. Mo Nutt
MAIL 272 San Gabriel Blvd. OCCUPANCY BK YAP PC
ADDRESS
CITY San Gabriel TEL YO At 94564
CONTRACTOR L.D.& M. Coast. Co. GiM.lNo Z7 3
ADDRESS 21 Wisteria Ave. JGBNO 3
CITY Arcadia TEL NO D062258 TRUNK PERMIT NO
38 STATE
REGISTRATION MO 115615 — 042 COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO 95 PERMIT ENCROACHMENT
PERMIT NO
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
NO OF BLOTS
812E OF LOT MOW ON LOT CHAR ES
USE OF
BUILDINGS Bea. CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER O $ 000 3160 RECEIPT NO DATE BY
NOUBE SEWER CONNECTINGT
PRIVATE DISPOSAL SYSTEM 100 "
CONNECT ADDITIONAL BLDG OR EXCEPTIONR RDED
WORK TO HOUSE SEWER 100
ALTER R[PA FR-EX FR—EXISTIND NO TE BY
SEWER OR DISPOSAL SYSTEM 100
t. DISCONNECT AND ABANDON SEWER
AMD OR DISPOSAL BVBTEM 1 00 CONNECTION DATA
8 0 TANK SEEPAGE PIT OR
PITS ANO OR DRAINFIELD 4.00 STATION ��'L�. O DEPTH
CE POOL-DRYWELL
SPECIAL CONDITIONS ONLY 400UPPER MA EFERENCE !�
TYPE OF CONNF ON �LEMOTH FROM 20
OWNM PERMIT f 1 00 T -SHRs P L M L TO P L
AUTHORIZATION I TOTAL FEE 1 4 150
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 DAY OF _19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_ BUILDING OR WORK
ADDRESS __ _ _ -_ -_ SEPTIC TANK BEEP.PIT(8)
- - -- — -- - - - - - - AND/OR GRAINFIELD
1 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 SEWEROR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT 1 AN PROPERLY REOISTERED
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTYFAIRANDON
BCOMNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- HOUSE SEWER
ER OF T14E ABOVE DESCRIBED RESIDENTIAL PROPERTY ALSEPTIC TA KEEP PIT(8)0 CESSPOOLY0
SIGNATURE
OF PERMITTEE_ L.D. R _
TOAOUm 00! 1/5E !l