HomeMy Public PortalAbout10672 SPARKLETT ST_Sewer__ 7
DEPAUTNEENT OF OOUNTY ENCMNEE t - SEWER-SEWAGE DISPOSAL 1
DIVISION OF ElUnMING AND SAFETY PERMIT APPLICATION
OOIINTF-OF LOS ANGELES
WILLIAM J. FOX, CODNY ENDIN[[q BUILDING
T // /�
ADDRESS 60 1072
FOR APPLICANT TO FILL IN LOCALITY q.L.{ -
ADDRESS 10672 $parklatt St. CNn�aT P&--C _
LOCALITY rpAML IA C i ty DISTRICT NO - SERIAL NO PERMIT NO.
NEAREST A S S
CROSS ST El Monte Ave. RE EIVED BY Rudy fir lot0..t1.[ DATE ISSUED
OWNER P.L. go Nutt /�.� �Ili--i6 -S=3
MAIL UG[ZOME OCCUPANCY MAP
ADDRESS 27-4 qan rnbrial Hl Yd. BK PB
C'Tttnn (Abri al TEL NO At. 9455F,4 -/
CONTRACTOR L.D. & 114 Constr. Co. ,NO C 27
ADDRESS 21 V7. 'U.Lstar18 Ave.
JOB No -5—
CITY ArC�dl , TEL NO T)o 62OSR TRUNKPERMITRO
STAT
R LEGAL
N0 11.3613 C 4P, a COUNTYE ROAD PERMIT NO
LEGAL
-DESCRIPTION LOT NO (j.3 STATE 6NCROACHM[MT
PERMIT MO
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO OF BLOBS
NOW ON LOT 1 CHARGES
USE OF
BUILDINGS Res, CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE
HOU BE SEWER CONNECTIN TO REIMBURSEMENT FEE
1 PUBLIC SEWER M $ S00 RECEIPT NO DATE BY
HOUSE SEWER CONNECTING O
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BL OR EXCEPTION RORDEO
WORK TO HOUSE SEWER 100 11-
A TERORREPAIFF-EMM ING NO DA E BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AMD OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK SEEPAGEPIT OR
PITS AND/OR DRAINFIELD 200 STATION ��jj/- d.S s' DEPTH
CESS L-DRY E L
SPECIAL CONDITIONS ONLY 200 I 0A NPP RREFEREHCE LIMB
ON
OF MNBMEe OMPL YEL TOPLON /Q
OWNERS PmMff t 1 00
ALIT HOULATION TOTAL FEE, 41 60
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19— NEW HOUSE SEWER a- ,
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT__ _ _ _ _ __.-_ __ _ _ _ _ BUILDING OR WORK
SEPTIC TANK SEEP PITIS) ,
ADDRESS _ __ _ _ _ _ _ _ _ _ _ _ _ ___ _ _ _ _ AMD/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL[3 DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWEROR
REGULATING PLUNGING AND SEWERS SEWAGE DISP06XL SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED DISCONNECT FLUB AND
AND/OR LICENSED AS REQUIRED BY LOB ANOELES COUNTY
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER 11""''II
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BEEP BACKFILL
LLSITIS) C TESSPOOLY0
OSIGNATURE
PERNiTTTEe sDt ht.QQnstr. Cn_ ,
TOAOISD 03 I/U Q 1