HomeMy Public PortalAbout10634 SPARKLETT ST_Sewer__ DEPAIGTBIENT OF COUNTY ENG]NEER { SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUMDINO AND SAFETY PERMIT APPLICATION
COMITY OF L08 AINOEL$S
WILLIAM J. FOX, COUNTY ENGINEER ADDRESS /O G
FOR APPLICANT TO RLL IN LOCALITY
ADDRESS 10634 Sparklett St. NEAREST
CR088 ST
LOCALITY Temple City DISTRICT NO. SERIAL NO PERMIT NO
CCROSSS S 191 Monte Ave. J A 9s2 d S
RECEIVED MY ReAOY for l..p.W.e DATE ISSUED
OWNER P.L• MON11tt A -11D
11 -S 3
MAIL 272 $An Gabriel Blvd. UBE ZONE OCCUPANCY SK
IMOA►
ADDRESS /'') BK PS
CITY San Gabriel TEL NO At94364 — / /CtiQ
CONTRACTOR L.D. & M. Canst. Co. op�rN.Mo e -L
ADDRESS 21 Wisteria Ave, JOB NO
6 6-
CITY Aroadia TEL NO _ Do6L238 TRUNK PERMIT NO
113613 - C42 STATE
REGISTRATION NO COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO 90 STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO OF BLOTS
NOW ON LOT 2 CHARGES
BUILSE DINGS Rea. & Garage CONNECTION CHARGE PEE
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTINS TO REIMBURSEMENT FEE
PUBLICSEWER aD F DSO 350RECEIPT MO TE I BY
HODS 8E-EVER roMMECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLOO OR EXCEPTI RECORDED
WORK TO HOUSE SEWER 100
TER OR REPAIR EXI IN NO DATE BY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 100 CONNECTION DATA
SEPTICTANK
PITS AMD/OR GRAINFIELDSEEPAGER 2A0
STATION d DEPTH
CEBSPO RYWELL
SPECIAL CONDITIONS ONLY ZAO i MHOLE REFERENCE
UPPER USWLE
TYPE OF COMNE IOMLENGTH FROM /
OWNERS PERMIT $ I 00 s e P Ly M L TO P L
RIZ �5
AUTHOATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TTH(E NNECTPBLITBE HE ABBOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS___DAY OF 19— NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT__ _ _ _ _ — _ __ _ _ _ _ _ BUILDING OR WORK
ADDRESS _ __ _ _ _ _ SEPTIC TANK 8[EP.PIT(8)
AMD OROMAI MFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL0 DRYWELL[j
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AMD BTATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISP06AL SYSTEM
AND/OR LBCEMBED IAB REQUIRED THAT I BY LROOPERLY S ANGELESSICOUNTTYY DISCONNECT PLUG AMD
AND BTATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER 0
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY AC F LL PTIC TANK II''''�I
SEEP PIT(8) CESSPOOLvo
SIGNATURE . & M. CnyIa*_ Go
OF PERMITTEE_ •D
T6A6611) MG 1/66 ��