HomeMy Public PortalAbout10666 SPARKLETT ST_Sewer__ DEPA]VrM0 TNT OF COUNTY ENGUgEEe )I SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUIT& ON 1:08 ANGELES
WILLIAM J FCX. COUNTY ENGINEER BUIL
1 BUIL B
FOR APPLICANT TO FILL IN rPERMIT
ITY
BUILDING ST
ADDRESS 10666 SporbrJott .5t BT
LOCALITY Temple City ICT NO SERIAL YO PERMIT NO
NEAREST r A / SO o
CROSS 8T T2l Ainnt.. Avw_ IVED BY Rndy fm ID.F..WN DATEISSUED
OWNERMAIL8 San P7 hr5ika Ulvd ONE OCCUPANCY BKYAP MAGGRESS $']�CITY San Gabriel TEL NO At 94364 �CONTRACTOR L:D. & M. COITSTR. CD.
NNo 01 ADDRESS 21 i7. V71starla Jive.CITY Arcadia TEL NO DO 62238PERMIT NOREGISTRATION NO 1136213 - C 42 COUNTYERMIT NOLEGALDESCRIPTION LOT MO - 84 NCROACHMENT NO
BLOCK TRACT 19189 INDUSTRIAL
NO OF SLOGS WASTE APPROVAL
812E OF LOT NOW ON LOT 2 CNA ES
USEOF
BUILOINBBCONNECTION CHARGE FEE
IPT
NO DESCRION OF W RK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICBEWER ® 1 860 RECEIPT NO DA E BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTI RECORDED
WORK TO HOUSE SEWER 100
ALTER ON REPAIR EXISTING NO ATE RY
SEWER OR DISPOSAL SYSTEM IDG
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION7L J i O DEPTH
ESSP L—DRYWELL / L
SPECIAL CONDITIONS ONLY 200 / MANHOLE REFERENCE
J'1 UPPER USIFGR
TYPE OF CONNEC�p N LENGTH FROM
OWNERS PERMIT : I 00 CLMB a P L ' M L TO P L Z o
AUTHORIZATION I TOTAL FEE 1 41 50
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS DAY OF_ 19— NEW HOUSE SEWER SGV0-G -17S¢
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT __ _ _ _____ _ _ _ _ __ _ BUILDINGORWORK
ADDRESS _ _ _ _ SEPTIC TANK.BEEP PIT(S)
—AND/ORD NFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- ICESSPOOL DRYWELL�
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL UNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBIN AND SEWERS SEWAGE DISPOSAL 8Y8TEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOB ANGELES COUNTY DISCONNECT PLUS AND
AND STATE OF CALIFORNIA OR THAT 1 AN THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY SACKFILL SEPTIC TANKSI�
SEEP PIT(8)E] CESSPOOL$O
OF PERYITTEEL.D. il: M. Ganatr♦ 4:1
TSANSD 613 1/SS /5y1 <1