HomeMy Public PortalAbout10629 SPARKLETT ST_Sewer__ DEPARTNEENT OF COUNTY ENGnYEEB SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
OOIINTB OF LOS ANGELES
WILLIAM J. FOX, COUNrY ENGINEER SUILDINp /O /
ADDRESS 0
FOR APPLICANT TO RLL IN LOCALITY
ADDRESS 10629 -2pariclett 9t , CROSSES
LOCALITY mwmnlw (?i ty DISTRICT No SERIAL NO. PERMIT NO
CROSS ST F1Tdnnte Ave. s A /'? C/���OS
¢EC IVED Y Rrft}xl"PaUmn _ DATEISWED
OWNER p T„ McNutt
Al
ADOO REBS Z 7Z-- San Gahm®l Blyd USE TONE OCCUPANCY RK YAP Po
CITY Ran (3ahri wl TELNO At. 94_364 _A- 1
CONTRACTOR L.Dl& M. Cont. Cm. R, ' Q _1 3c74
ADDRESS 21 Wisteria Ave. JOB.No 6s--6-
CITY
S6-CITY Arcadia TEL NO ]062238 TRUNK PERMIT NO
REGISTRATION NO 113613 - 042 - :9 COUNn'
ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO STATE ENCROACHMENT
l OO PERMIT NO
BLOCK TRACT l g gg INDUSTRIAL
WASTE APPROVAL
S12E OF LOT NO OF BLDG8
NOW ON LOT Z CHARES
UBE OF
BUILDINGS Rep . & Garaize CONNECTION CHARGE FEE
NO DEBCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONN IN TO
PUBLICSEWER ® 560 RECEIPT NO D E BY
HOUSE SEWER CONNECTINS TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT DDITIONAL BL GOR EXCEPTION ECORDED
WORK TO HOUSE SEWER 100 NO 0 TE BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 100
AND ORNECT AND DISPOSAL SYSTEMN SEW ER 100 CONN ON DATA
SEPTICTANK SEEPAOEPITOR i
PITS AND/OR GRAINFIELD 100 STATION Qf DEPTH �n
CESSPOOLr-DRYWELL
SPECIAL CONDITIONS ONLY 100 MANHOLE REFERENCE
�, S � MPTBR E LOWER
TYPE OF CONNECTION LENOTH FRO■
OWNERS PERMIT $ 1 1 OD GL+lts P L ML TO P L 2 S
AUTHORIZATION I TOTAL FEE 1 4 50
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOWSSIONATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS _ DAY OF __ __— 19_ NEW HOUSE SEWER S �-
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ _ _ _ _ _ _ __ BUILDING OR WORK
SEPTIC TANK SEEP.PITH)
ADDRESS AND/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL�
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAI pp,,8[W[R Oq
REGULATING PLUMBING AND SEWERS SEWAGE OIBPoBAL SER on
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
EM
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY OIL TIOA "'I
BEEP PIT(S)[] OESSPOaVE]
OF PERMRITTEE
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