HomeMy Public PortalAbout10619 SPARKLETT ST_Sewer__ DEPASTNIENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
OOUNTY-OF 1,08 ANGEIX8
WILLIAM J FDX, COUNTY ENGINEER BUILDING Q /
AODRERS b
DIFOR APPLICANT TO FILL IN LOCALITY
ADDRESS 10619 Sparklett St. NEAREST
CR068 ST
LOCALITY Temple City DISTRICT NO SERIAL NO PERMIT NO
NEAREST S A /9,SZV_yy S/ ( S
CROSS ST 191 Monte Ave,
RED VE D Y gNdY f.F IA.pKII,L DATE ISSUED
OWNER p,L. McNutt /2-i6-s3
MAIL 2.�yy UBE ZONE OCCUPANCY MAP
ADORERS 27p�r $aII Gabriel Blvd. /,/�� SK PG
CITY SanUbrjel TEL NO At. 84364 / / 2'p
CONTRACTOR L.D, & M. Const, CO, CB+1111110=00 o'4Cj ?3S4
ADDRESS 21 Wisteria Ave. JOB No 4673—
CITY
S3—CITY Arcadia TEL NO DO 62238 TRUNK PERMIT NO
STATE
REGISTRATION NO 113613 - 0 42 COUNTY ROAD PERMIT NO _
LEGAL
DESCRIPTION LOT NO 99 STATE ENCROACHMENTPERMIT NO
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
)F
NO
812E OF LOT NOW
OYBLDOS
LOT _ CHAR ES
USE
BUILDINGS Res. & Garage CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
OUSE SEWER CONNECTING TO
PUBLICBEWER a L SLL 3 b0 RECEIPT NO TE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM IOL
COMNECTADDI IO�T-- NAL BLDG OR EXCEPTI RECORDED
WORK TO HOUSE SEWER I LL NO D Tfi BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM IOL
DISCONNECT AND ABANDON SEWER
AND/08 DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR /
PITS AND OR DRAIN FIELD 2AO STATION 04-?Q DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200MANHOLEp REFERENCE W LOWER
TYPE OF ONNECTION f� LENGTH FROM L /
OWNERS PERMS $ I I oo P L ML TO P L 5
AUTHORIZATION I TOTAL FEE 1 4160
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOWSSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS _ _ _DAY OF 19 NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AOENT _ _ _ _ _ __ _ __ _ BUILDING OR WORK
SEPTIC TANK,SEEP PIT(S)
ADDRESS AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS AP►LI- CESSPOOL[:] DRYWELL
CATION 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 BEWARE DISPO�SEWER R
AMD/OR LICEI HEREBY NSED IFY THAT I AN AS REQUIRED BYPROPERLY ANGELESCOUNTYDISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY SEEP PITlB)� IC TAN
SIGNATURE OLYO 1
OF PERMITTEE LJl 1&M _ _ _ _ __
7SALJSD 002 1/53 t