HomeMy Public PortalAbout10628 SPARKLETT ST_Sewer__ DEPAICTD024T OF OOUNTT ENGINEER, SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
.DOIINTY OF LOS ANOET
WILLIAM J. FOX, COUNTY ENDIN[[R BUAGGREILDINGSS /O /2
firF,9610628
APPLICANT TO RLL IN LOCALITY
8 Sgarklett 9t.
NEAREST
o 01ty Blvd. DISTRICT NO {ERIAL NO PERMIT NO.
onte Ave. A /S
SECIVY R.Adf Tor I..pwtl.0 DAT[1 [D
McNuttADE88 'IB an Gabriel Blvd. USEZONE OCCUPANCY YAP
/� BK PO
clTdan Gabriel TEL NO At 91}364 �/ /`N–'n�-�C"f
CONTRACTOR L.D.&M. Coast. CO. G til3'y4
ADDRESS 21 Yheteria Ave. t
JOB RO �V
CITY Arcadia TEL NO D062238 TRUNK PERMIT NO
REGISTRATION NO 113613 - C 42 STATE
COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO 91 STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT 19189 INDUSTRIAL
NO OF BLDGS WASTE APPROVAL
SIZE OF LOT MOW ON LOT CHARfIES
USE
BUUIILDINGS Rose & Garage CONNECTION CHARGE FEE
NO DEEICRIPTION OF WORK FEE
HOUSE SEWER CONNECTIM TO REIMBURSEMENT FEE
PUBLICSEWER a { 860 3 50 RECEIPT NO E BY
HOUSE SEWER CONNECTING TO
P RIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BL O OR EXCEPTIO RECORDED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING O DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA
SEPTIC TANK SIEEPA09PITon
PITS
AND/OR DRAINFIELD' 2.00 STATION Q.( a DEPTH
C B8 OL--0RYWELL
SPECIAL CONDITIONS ONLY 200 66 1 MANHOLE REFERENCE /� LOWER
TYPE OF CONNECTION LENGTH FROM /
'T" Lana P L /� M L TO P L /
OWNERS PERMIT f 1 00
AUTHORIZATION I TOTAL FEE 4 60
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS_—DAY OF 19_ MEW HOUSE SEWER SO D G
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT __ _ _ __ _ _ – _ _ BUILOINGORWORK
ADDRESS _ _ _ _ _ _ SEPTIC TANK.SEEP PIT(8)
AMD/OR DRA NFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL 0 ORYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
AND%OR LICEEREBY NSED IAB THAT
AN PROPERLY
ANGELESSICOUNTD'
DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY RACKFILL SEPTIC TANKS SIGNATURE 11��1
BEEP PIT(B)0 CESBPOOL$0
OF PERMITTEE. _LeDi .Ie .
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