HomeMy Public PortalAbout10667 SPARKLETT ST_Sewer__ 75A 64ID -CESOS-10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEW E DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING b
ADDRESS n
LOCALITY ♦ (..1
N[1R[!T
LEG
FOR APPLICANT TO FILL IN CRDSS Sr
OESCRII: ION LOT NO
OWNER
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BLOCK TRACT /III • ADDRC88
[, NO OR BLD06
812E or LOT v NOW ON LOT CITY TEL NO
US[ OF DISTRICT NO SROUP MAP CE9lEO 8Y
BUILDINGS
SX PB
S0 8 y - E
CONTRACTOR
ADOR[ep (` CONNECTION DATA
CITY qq //�� / TEL NO s 7-7 STATION O O DEPTH
8 C[HSC NO 1-06 L'] CLASS I MANHOLE REFERENCE 77--s-s UPPER
/ MWB R
NO DESCRIPTION OF WORK PEE TYPO OF CONNECTION L[NO ROM
MOUSE SEWER CONNECTING TO Y CURB �_ M L TOP L
PUBLIC SEWER 0 $700
SEPTIC TANK SEEPAGE PIT OR PC NO
PITS ANO/OR DRAINPIILD 0 !10 DO CO IMP NO JOS MO a
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PIRMR NO per,
PRIVATE OISPOSAL SYSTEM 0 saw O
CONNECT ADDITIONAL BLDG OR i) AFFIDAVIT uvTY [p[Y[YT RECORD INSTfl NO DATE v
WORK TO HOUSE SEWER 0 slop !/
OVERFLOW SEEPAGE PIT GRAINFIELD of
[XTM CQBSPOOLORYWELL 0 SS OO HWY OR ST WIDENING O
ALT.. REPAIR OR ABANDON MOUSE3V•
SEWER OR DISPOSAL SYSTEM 0 SS 00STAT[ENCROACHMENT
EW
MANHOLE 0 $700 PERKIT NO
a
INDUSTRIAL N
WASTE APPROVAL Z
OWNMS PERbUT s S 00 CHARD"
AUTHORMATION TOTAL FEE 00
CONNECTION CHARGE P[[
I HAV[ AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC S[ APPROVALS DAT[ ACTOR ONATURE
SIGNED THIS Y O 19
OWNER OR NEW HOUR[SEWER J
OWNERS AGENT
CONNECT ADDITIONAL
AGGRESS
BUILDING OR WORK
BEPTICTANK S[[P PITIS)
I HEREBY THAT
THE ABO THAT 1 HAVE ROAD THIS APPL ICM ION AND/OR GRAINFIELD
AND
STATE THAT TME ABOVE IB CORRECT AND LAWS
E COMPLY
WITH ALL AND
SIK ORDINANCES
AND STATE LAWS RIOU LATINO ❑
PLUMBING ANO SEW CRS CESSPOOL ❑ DRYW ELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AMD/OR ALTER REPAIR SEWER OR
LICENSED AS N[OUIRED BY LOS ANGLES COUNTY D STATE OF IS SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR M THE LEGAL TOR OF O INT NO TO DISCO CT PLUG AND
RfSID[ Iry ASOV[ [SC ED RUI IAL P RT ApA O HOU.K.KWER
SIGN ATUR[
OF PERMTTT[[ BA< ILL EW C TANKS ❑
S[E PIT 81 ❑ QBBPOOLE
VAE TIO CK M 0 CASH
Lilo 0 4 3 7 WJAN 4 1 0 0 6.0 0-
76 A 642D-CESOS-10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
AODK
LOCALITY
FOR APPLICANT TO FILL IN cecea`eT
DAL
[OLOCK
scRIFTIGN LOT No OWNER
MAIL
TRACT MAIL
No
ZE OF LOT X N.WoONBL.T` �Q�� CITY TEL NO
E OF
LOINGG DIST41CTND I SROUP BK MAP PROCls6e er
CONTRACTOR
ADDRESS —7Z, I CONNECTION DATA
CITr TEL NO yd/5 77NATIONi DEPTH
STATE �1 LIC UPPER
LICENSE NO �V CLASS / MANHOLE REFERENCE
J�
NO DESCRIPTION WORK F[[ TYPE OP CONNECTION LENGTH M l
MOUS[SEWER CONNECTING TO o-v Y CURS PL Y L TO L
PUBLIC TANK O $7 00 (/V PC NO
SEPTAN TANK SEEPAGE PIT Off CO IMP NO
PITA AHD/OR GRAINFIELD O $1000
HOUS9 M9R CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO a
PRIVwT[DISPOSAL SYSTEM O S)00 O
CONNECT ADDITION AL SLDO Ofl AFFIDAVIT RYY.L Y.I.S.RT R[CORO IMpT11 NO DAT[ u
WORKTO HOU BE
S[W[R O Si 00
OVERFLOW SEEPAGE PIT GRAINFIELD d,
EKTN CESSPOOLDRYW[LL O SSW O
ALTER REPAIR OR ABANDON H OU
BAND NHOU HWY QRST WIDENING
SEWER OR DISPOSAL SYSTEM O $3 GO STAT¢ENCROACHMENT ty'
MANHOLE O $7 OD PERMIT NO y
INDUSTRIAL y
WASTE APPROVAL 2_
CHARGES
OWNEErS 3 00
CONNECTION CMAflO[FEE
AUTHOATLATION rorAr. FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COM REIMBURSEMENT F[[
TRACTOR TO CONNECT THE ABOVED/Ews I[[D TL}�
TO TH[ PUBLIC SE R ` PpoV O TC INSPORS SIO TURC
SIGNED THIS DAY OF 19
OWNER OR NEW HOUSE SMER
If
OW NCRi AO[NT
CONNECT A I
ADDRESS BUILDING ORR WORK
¢OPTIC TANK SEEP PIT(S)
I HERESY THAT
TH ABO THAT I HAVE ROAD THIS APPLICATION AND/OR GRAINFIELD
AND STAT! THAT THC ABOVE IE CORRECT AND AGREE E COMPLY
WITH ALL COUNTY ORDINANCES AND STAT[ LAWS R[OUlJ1TIM0
FLU BASING AND SIWCRS CESSPOOL ❑ DRYW[LL ❑
1 HERSEY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LIClN6LD AS REOUIRID SY LOS ANGLES COUNTY AND STAT! OF SWAG C DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM THE LEGAL OWNER AND I NO TO
DISCONNECT PLUG AND
RESIDE IN THE A DLSCRI D R[p10[NTI RO ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ❑
OF PEflYRT[C S[V PITISI q=POOLB Y
VALIDATION CK M 0 CASH
L ko 7 0 7 5;3 JUL 19 1 0 D 1 0.0 O-