HomeMy Public PortalAbout10647 SPARKLETT ST_Sewer__ DEPARTMENT OF Comvrrr EN(IYEEB SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
00tiNrx OF'-LOB ANGELES
WILLIAM J. FOX, CDuNT ENGINEER ADDRESS O
47
FOR APPLICANT TO FILL IN LOCALITY
ADDRESS 10647 Sparkiett St. CROSS BT 0-0e
LOCALITY 117emplp .i ty DISTRICT NO S SIAL NO PERMIT NO
CRO888T El Monte Ave. 5 A 9 J03 S
RE EIVED BY R.Ady for Imp"m DATE ISSUED)
OWNER P,T, MONutt
ADDRESS 2721 San (Sabriel RTvd. USEZONE ANCY I EMAP PG
CIT`' ' San Gabriel TEL NO At. 94364
CONTRACTOR T_T)_ Oat_ (:O_ OQzMU6MO `
ADDRESS 21 WiBteria Ave, JOB NO 9'; .J
CITY Arcadia TEL NO D062238 TRUNK PERMIT NO
REGISTRATION NO I T?S Al :3 - C 42 PF
COUNTSTATEY ROAD PERMIT NO
LEGL
DESCRIPTION LOT NO 103 STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT 19189 WASTE APPLRDVAL
SIZE OF LOT NO OF BLDCB 2 CHAR 8
Garage NOW ON LOT
USEOF
BUILDINGS &_Garage CONNECTION CHARGE FEE
NO DEEICRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $ 850 3 60 RECEIPT NO ATE BY
HOUSE SEW
IVATE
PRER CONNECTING TO
DISPOSAL SYSTEM 100
CONN CT ADDITIONAL BLDG OR EXCETION RECORDED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING NO DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCOMMECT AND ABANDON SEWER
AND/Of1 DISPOSAL SYSTEM 1 00 CONNECTION DATA
SE PTIOTAMK,SEEPAGE PITOR /
PITS AND/OR DRAIMFIELD 200 STATION I-t*j? O DEPTH (�
CEBRPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 f 1 ANHOLE REFERENCE
Y3 UPPER OQ1MiR
TYPE OF COMNE IDM LENGTH FROM ,( s'
OWNERS PERMIT = I 00 sum PL �� M L TO P L i. J
AUTHORIZATION I TOTAL FEE 4 60
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTORS SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS _ _ DAY OF _ ____19__ NEW HOUSE SEWER -
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ _ _ _ _ __ _ _ __ BUILDING OR WORK
BEPTICTANK BEEP PIT(S)
ADDRESS AMD/OR GRAINFIELD
I 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 DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AMD/OR LICENSED AS REQUIRED BY LDS ANGELES COUNTY DISCONNECT PLUG AND
AMD STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SPTANKS
BEEP PITS)C] CESSPOO nO
SIGNATURE 7..D. & M COnst� Co.
OF PERMITTEE _ (/
TSA6UD 60 1/55