HomeMy Public PortalAbout10656 SPARKLETT ST_Sewer__ DEPA CTWENT OF OOIINxY ENGINEER 'I . SEWER--SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOB ANGELES /
WILLIAMJ. EN
J. ENDIN[[R ADDRE38 �D (0 510
FOR APPLICANT TO-FILL IN LOCALITY
ADDRESS 10656 Sparklett St. NEAREST
LOCALITY Temple.City DISTRICT NO. SERIAL NO PERMIT NO
GRO888T Bl Monte Ave. pp A I9S'l-� -8(D5
-0 EIVED BY RgdT 1w I..pwWe DATE ISSUED
OWNER P.L. McNutt .JY�/�
ADDRESS 2721- San Gabriel Blvd. USE zomE OCCUPANCY MAP
CITY San GabrierbL No At 94364 BK Pa
CONTRACTOR L.D. M. Const. Co. e[PNo Q 7 3
ADDRESS 21 Wisteria Ave. NRw1OBNo 6 S S
CITY Aroadia TEL NO DO 6...23E TRUNK PERMIT NO
REGISTRATION NO 113613 -042 STATE
COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO E6 PERMIT NOROACHMEMT
BLOCK TRACT 19169 INDUSTRIAL
WASTE APPROVAL
SI2E OF LOT NO OF BLDGB
NOW ON LOT 2 CHARGE
USEO
BUILDINGS Res. & Garage
CONNECTION CHARGE FEE
NO DEBCRIF?ION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIOSEWER a $ SMI 360 RECEIPT NO TE BY
HOUSE SEWER CONNECTING
PRIVATE DISPOSAL SYSTEM ISO
CONNECT ADDITIONAL BS R EXCEPTIO ECORDED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING NO ATE BY
SEWER OR DISPOSAL SYSTEM IAO
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 SO CONNECTION DATA
SEPTIC TANK SEEPAGE I R
PITS ANO/Ofl DRAINFIELD 2.10 STATION {• 3 81 O DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 // / MANHOLE GEFEBENCE £- LOWER
W�TYPE OFA CONNECTION �B�LE`TMXP FROM
OWNERS
PER
$ I OD
AUTHORIZATION TOTAL FEE 4 60
1 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 DAY OF 19_ NEW HOUSE SEWER $C
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_ _ — _ _ _ _ _ ___ _ _ _ _ _ BUILDINGORWORK
SEPTIC TANK BEEP.PIT(S)
ADDRESS - AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL 0 DRYWELL❑
CATION AND STATE THAT THE ABOVE IS 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 AN PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
ANO STAT[ OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER I'"I
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY SEEP ILLSEPTIC TANKS
SIGNATURE L.D & M . Coast. Co.
OFPERNITTEL_�_ _
TSA"M W 1/53 o..