HomeMy Public PortalAbout10635 SPARKLETT ST_Sewer__ DEPARTMENT OF COUNTY ENS SEWER-,SEWAGE DISPOSAL
DMSION OF BUMDING AND SAFETY PERMIT APPLICATION
COUNTY (W LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING O / LC
ADDRESS (O
FOR APPLICANT TO RLL IN LOCALITY
BUILDING NEAREST
ADDRESS �e�.gg q1 Rr k1Att Q}_ CROSS ST
LOCALITY DISTRICT YO SERIAL NO PERMIT NO
Temple City
NEAREST j A /yS21�-ia/ S
CRO88 ST F;l Mnrtn AVA. E IVF BY RaOTTor1uD..UoO DATEISSUED
OWNER p.L_ raoilutt /2-/6-3 3
MAIL USE 20NE OCCUPANCY YAP
ADDRESS P7P� San GBbsiel 81vd RK PD
CITY San Gabriel TELMO 3 .. 94364
CONTRACTOR L.D. & M. Consat . Co. amosme e 1- 73
ADDRESS 21 Wigte Tia Ave . JOB.NO S l
CITY Arcadia TEL NO DO 622238 TRUNK PERMIT NO
REGISTRATION NO 113613 - C 42 ❑ TATE
ROAD PERMIT NO
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO lO1 PERMIT NO
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
814E OF LOT NO OF BLDOS CHARD 8
NOW
ON
LOT 2
UBE OF
BUDINGS CONNECTION CHARGE FEE
IL
NO DESCRIPTION OF WD K FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTINO1170
PUBLICSEWER a 11 SBo RECEIPT NO E BY
HOUBE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM ISO
CONNEC ADDITIONAL BLDG OR EXCEPTI N RECORDED
WORK TO HOUSE SEWER IOD NO DATE BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 100
T AND AMD OR DISPOSAL SYSTEM ABANDON SEWER 100 CONNECTION DATA
SEPTIC TANK SEEPAGE PITON
PITS AND/OR GRAINFIELD 400 STATION ��3�t DEPTH CO
SPC 88POOL–DRYWELL
ECIAL CONDITIONS ONLY 400 �� MANHOOLLEpREFERENCE W LOWER
TYPE OF CONNECTION �/ LENGTH FROM /L...s
OWNERS PERMIT $ ) 00 euiw PL Y L TO P L
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLINR TO THE PUBLIC SEWER /
SIGNED THIS __ DAY OF __ _ _19— NEW HOUSE SEWER I -Sca4encit - Sf'
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ _ _ __ _ _ _ 13UILDINGORWORK
SEPTIC TANK BEEP.PIT(S)
ADDRESS _ _ _ _ _ _ _ _ _ _ _ _ AND/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL[] DRYWELL�
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 DISPOAL SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED DISCONNECT PLUG AND
AND STATE OF011 SCAL CALIFORNIA OR THAT ED AS REQUIRED BY 1 Ar THANGE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTICTANKSSIGNATURE I"'�
BEEP PIT(8)0 CESSPOOLS
OF PERMITTEE
TOA"W OSB I/w A D