HomeMy Public PortalAbout10653 SPARKLETT ST_Sewer__ DEPARTAKEM OF OOUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
Divisiox OF BUnMING MW SAFETY PERMI
OT APPLICATION
OUNtY OF LOS ANGELES Bu1LDlxD /
ov
WILLIAM J. FCX, COUNTY ENDINE[R ADDRESS O
FOR APPLICANT TO RLL IN LOCALITY
BUILDING 7065'3 ST)Fir la . . S .. GROSNEAS BT O�
LOCALITY Temple City DISTRICT NO SERIAL NO PERMIT NO.
NEAREST A SL -In r
CROSS BT E1 Monte AV e. RECEIVE BY R..dY fa INVWU.O DATEISSUED
OWNER PJ.. mallutt �'- _'C3
ADDRESS 972' 'Ran(3abri_gl_ 'RlyA. US[ZONE OCCUPANCY BK MS PS
CITY San (Gabriel vTELNO At. 94364 -
CONTRACTOR L. D. & M. Const, Cc. OBom"MO
ADDRESS 21 Wisteria St. )OB.NO
CITYA,Oadi$ TEL NO Do 62238 ATETRUNK PERMIT NO
REGISTRATION NO 113613 - C 42BY
COUNTY
ROAD PERMIT NO
DEEGAL
SCRIPTION LOT NO 104 PERMIT ENCROACHMENT
NO
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO OF"LOGO
NOW ON LOT 2 CHARD
USE OF
BUILDING $ CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONN[ MGTO
PUBLICBEWER @ S 350 RECEIPT MO DATE BY
HO USE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONN CfA601TIOPIAL BLDG OR EXCEPTI RECORDED
WORK TO HOUSE SEWER I W NO
SER OR REPAIR EXISTING TE BY
SEWER OR DISPOSAL SYSTEM 100
0ISCOMNECT AND ABANDON SEWER
AMD/OR DISPOSAL SYSTEM IDo CONN ON DATA\
SEPTIC TANK,SEEPAGE PIT OR /
PITS AND/OR GRAINFIELD 200 STATION .f- DEPTH
C
Egg POOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 /T1 / YANROLE REFERENCFE LOWER
TYPE OF CONNECTION LENGTH FR Y
OWNERS PERMIT f 1 00 alr CNN° P LyM L TO P L �-5
AUTHORIZATION I TOTAL FEE 4 50
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS _ DAYOF __ _ __19___ NEW HOUSE SEWER ,rj
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ __ _ _ _ _ _ BUILDINGORWORK
SEPTICTANK SEEP PIT(S)
ADDRESS ANO/OR GRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL DRYWELLO
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR S[W[R OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
1 HERESY CERTIFY THAT I AN PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AN THE LEGAL OWN ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BAGICTILL
T BEEP PIT(S)[] CESSPOOLS[3
SIGNATURE [3
OF ERMIITTEE T.- T'
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