HomeMy Public PortalAbout10612 SPARKLETT ST_Sewer__ DEPAICTRIINT OF COUNTY ENONEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUMDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANOELffi
WILLdAM J.-FOX. COUNTY £NOINEER ABDRESS /0 61 s 1
FOR APPLICANT TO FILL IN LOCALITY
BUILDING ADDRESS 10612 Sparlclett 9t. MNERARaST '
LOCALITY Temple City DISTRICT NO GENIAL NO PERMIT NO
GROSS ST $LMonte Ave. , s A q - 3 $
OWNERP.L. MCNLltt R CEIVE BY R.a*fw l..o.ame DATEISBUED
ADDRESS 2724 San Gabriel Blvd. USE ZONE OCCUPANCY BK MAP PG
CITY San Gabriel TEL NO At 94364 /
CONTRACTOR L.D. & M. Const. Co. Ne FC J- 3
ADDRESS 21 Wisteria Ave.
ioRNo r
cmArcadla TEL NO Do62238
�] TRUNK PERMIT NO
REGISTRATION NO 113 }
613 � C42 p COUNTr
ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO 93 STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT 19189 INDUSTRIAL
NO OF BOBS
WASTE APPROVAL
812E OF LOT MOW ON LOT 2 CMAgO
BsfF
UIILDINGS Res. & Garage CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIOSEWER 0 S 3.50 3
RECEIPT NO D TE BY
HOUSE SEWER CONN TING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDIIONAL BL OOR EXCEPTION CORDED
WORK TO HOUSE SEWER 1 00
AL ER OR REPAIR EXIST MG NO D TE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AMD/OR DISPOSAL SYSTEtl I Do CONNECTION DATA
PTICTA .8EEPA0E IT OR
PIT,AND/OR GRAINFIELD 200 STATION f(j/� DEPTH
CE88P Lr DRYWELL
SPECIAL CONDITIONS ONLY 200 �Ol si MANHOLE REFERENCE t„ LOWER
TYPE OF CONNECTION L A� LMEM TO FRO /�
OWNERS PERMIT { 1 00 46"
AUTHORIZATION TOTAL FEE 6 b0
I 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 S -/
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ _ __ __ __ _ _ _ _ _ _ BUILDINGORWORK
ADDRESS _ - - AMD�ORDRAIMFI[LD PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWEROR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
AND/OR LICE CERTIFY D AB QUIRED BYPROPERLY
OS ANGELESGICOUNTY DISCONNECT PLUS AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-GO An,
HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL CTANKS
n(�
SIGNATURE L SEEPPIT(8)[] CESSPOOLVO
OF PERMITTEE. __ �A& ,yam
78A8/2D 40 1/0 _ �11w 1