HomeMy Public PortalAbout10640 SPARKLETT ST_Sewer__ DEPAIPPIIIUNT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUi= OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENDIH![R BUILDING d
ADDRESS /O
FOR APPLICANT TO FILL IN LOCALITY
ADDRESS 10640 Sparklett St. NEAREST
CROSS ST
LOCALITY Temple City 019TIUCT No [[RUL NO PERMIT NO.
NROSS
NEEAREST Rl Monte Ane. A
R EIV[ BY
UBE ZON!
R.a4 hU
r I0.0.. .N DAT[ISSUED
OWNER p.L• 31o&Utt ./ –14
ADDRESS L ESS 272 1 San Gabriel Blvd. OCCUPANCY MAP
BK PO �
CITY San Gabriel TEL No At 94304 _
cONTRAcToRL.D.& M. Cunst. Co cGaMN.rG
ADDRESS 21 Wisteria Ave. IOBNC � -S-
CITY Aroadia TEL NO Do 62238 TRUNK PERMIT NO
REGISTRATION NO 113613 - C 42 COUNTY
ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO 89 PERMIT INIONOACNMEMT
BLOCK TRACT 19189 INDUSTRIAL
NO OF BLOBS .z WASTE APPROVAL
812E OF LOT NOW ON LOT CHABGEB
USE OF
BUILDI NGGRea. & Garage CONNECTION CHARGE FEEEI
MO DECRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO 3 REIMBURSEMENT FEE
PUBLIC SEWER Y 5 850 RECEIPT NO DATE IBY 1
HOUSE BEWERCONM TINGTO
PRIVATEDISPOSAL SYSTEM 100
ONNE TAD ITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER OR REPAIR EXISTING NO ATE BY
SEWER OR DISPOSAL SYSTEM IN
DISCONNECT AND ABANDON SEWER
AMD/OR DISPOSAL SYSTEM 150 CONNECTION DATA
SEPTICTANK BEEPASEPITOR
PITS AND/OR DRAINFIELD 200
EPL-oWELL STATION '14- p DEPTH
BP[GIAL CONDITION80NLV 200 A HOLEEFERENCE
UPPER
TYPE OF CON CTIOM LENGTH FROM /
OWNERS PERMIT f I 00 P L `_M L TO P L S
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTINGAPPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS——DAY OF_ _19_ NEW HOUSE SEWER 5' G – 4
OWNER ON CONNECT ADDITIONAL
OWNERS AGENT____ _ ___— _ _ _ _ _ BUILDING OR WORK
ADDRESS _ _ ANO/OR AN DRAINFIESEELD IT/S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL DRYWELL0
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
AMD/011 LICEEBY NSED CERTIFY
REQUIRED BY LNOS ANGELES COUNTERLY Y DISCONNECT PLUG AND
AMD STAT[ OF CALIFORNIA OR THAT I AN THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILLSePTJCTANks�I
SIGNATURE SEEP PIT(S) CEBBPOOLY0
OF PERMITTEE. LCD._& MzCOnsL• QO.
TRANZD RRR 1/53 /� !i