HomeMy Public PortalAbout10606 SPARKLETT ST_Sewer__ DL^PAIMIMLENT OF OOIINTY ENCHNEEIL SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILMING AND SAFETY PERMIT APPLICATION
CODDPPY Gm' LOS ANGELES
WILLIAM J. FOX, COUNTY ENo1N[[ ADDRE
N MS O G O G
ADDRESS
FOR APPLICANT TO RLL IN LOCALITY
BUILDING
10606 Sparklett St. DNeoSSRCS
LOCALITY Temple City DIBTNICT NO S[NIAL NO PERMIT NO
NEOa
NEAREST
Bl Monte Ave. S A
MoNutt E VE BY Rad/fn IppwO.n DATE ISSUED
OWNER P.L. /'LMAIL
ADDRESS 2722 San Gabriel Blvd. USE ZONE OCCUPANCY ON
YAP PB
CITY San Gabriel TEL NO At 94364 — / V////``�1�a_
CONTRACTOR L.D.& M. Const.- Co. 090LErr0 i C..
ADDRESS 21 Wisteria Ave* IDB No
CITYArOadia TEL NO DO 62888 TRUNK PERMIT NO
REGISTRATION NO 113613 - 042 couflTr
ROAD PERMIT NO
LEGAL 94 STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
NO OF OLD"SIZE OF LOT NOW ON
LOT 1 CNApSEB
USE OF
eUIL01N08 1613. CONNECTION CHARGE FE[
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
PUBLCBBEWER�NNEOTIMO TO 0 $ 360 3 b0
HOUSE SEWER CONNECTING TO RECEIPT NO DATE BY
PRIVATE DISPOSAL SYSTEM 100
CONNEdT ADDITIONAL BLOd OR EXCEPTIONCORDED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING NO DA SY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR /
PITS AMD/OpDMINFIELD 200 STATION /f SLI O DEPTH (a
00 RYWELL
SPACIAL CONDITIONS ONLY Z00O E 0 WHOLE REFERENCE
UPPER
r TYPE OFF ONPL 4�YEL TOP LROM 3d
OWNERS PERMIT f I 00
AMORRATION TOTAL FEE 4 b0
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO
CONNECT PUBLTE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO ER
SIGNED THIS_—_ _.DAY OF_ IY_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT __ _ __ _ _ _ _ __ _ _ _ BUILDINO OR WORK
SEPTIC TANK BEEF.PIT(S)
ADDRESS _ AMD/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELLO
CATION AND STATE THAT THE ABOVE IB CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWEROR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOIIAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STAT[ OF CALIFORNIA OR THAT 1 AY THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPYiU TANKU��''II
SIGNATURE L BEEP PIT(S)0 CESSPOOLS
OF►ERNITT[E •D._� M. QOnat- 00- _
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