HomeMy Public PortalAbout10673 SPARKLETT ST_Sewer__ 75A SSZD -CE808-10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION pulLDlnD
ADDR[YY DGS
LOCALITY
FOR APPLICANT TO FILL IN NEAREST
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LEGAL
DepCRIPfION LOT NO OWNER
/ M. 3r9y MAIL
BLOCK TRACT ADDRESS
NO Or BLDG.
SIZE OF LOT NOW ON LOT CITY TEL NO
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BUILDINGS OISTLICT NO GROUP R P
MAR CESSED BY
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CONTRACTOR
/ V V
wpDlNepe O 3 [ CONNECTION DATA
CITY /`T /� TCL ND S 977 Z STATION Ay L�OCIIH
.TA TELICENSE NO 6 0 -q� GLA.. MANHOLE REFERENCE / J`/`/J� UPPER
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION _J LeNGTN OM
HOUSE SEWER CONNECTING TO Y CURB PL ML TOP L
PUBLIC SEWER 0 $% 00 PC NO
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PEPTIC TANK SEEPAGE PIT OR CO IMP NO JOB NO Q2
PITS AND/OR GRAINFIELD d {1000
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO Q.
O
00
PRIVATE DISPOSAL SYSTEM 0 []
CONNECT ADD ITIONAL BLDG OR AFFIDAVIT [M[[[ [A[[R[rt RECORD INBTR NO DATE U
WORK TO HOUSE SEWER C f300
OVERFLOW SEEPAGE PIT GRAINFIELD O
E%TN CESSPOOL DRYWELL 0 55M
ALTER REPAIR OR ABANDON HOUSE HWY OR BT WIDENING
SEWER OR DISPOSAL SYSTEM Y $300
STATE ENCROACHMENT W
MANHOLE 0 tT 00 PERMIT NO O_
INDUSTRIAL y
�}�p IT WABTE APPROVAL Z
O��YY EM'S PERM $ p 00 CHARGES
AUTHORIZATION TOTAL FEE /I CONNECTION CHARGE FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT FEC
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING ACC80VA�
TO THE PUBLIC SEWER ''''JJ'� Ll •ALS DATE PCCTO .SIO NATURE
SIGNED THIS DAY OF 19jA
OWNER ORryEW HOUSN
E 6[WER
OWNERS AGENT COnN[CT ADDITIOAL
ADDRESS-40 , BUILDING OR WORK
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIB APPLICATION PEPTIC TANK SEEP PIT(S)
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR GRAINFIELD
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED ANO/OR ALTER REPAIR SEWER OR
LICENSED A8 REQUIRED BY LOS ANGLES COUNTY NO STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT AM THE LEGAL OW ER O ND INTEND TO
RCBIDC IN THE A E pESCN)BED RE81 TIA R [ AI HD DISCONNECT PLUG AND
(//j_// _ DISCO N HOUSE SEWER
SIGNATURE
OF
PERMITTEE SACKPI SEPTIC TANKS
BEEF Film 2=qpooLS
VALIDATIO cK M 0 CASH
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76A 642D—CEe0e-10.71 APPLICATION FOR PERMIT' ,
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL C'1ulll
DEPARTMENT OF COUNTY ENG4'�� AD
BUILDING AND SAFETY DIVIDING �. P�
ADDRESS
LITY
FOR APPLICANT TO FILL S SppT
LCOAL
AL
D[{C..-' M LOT NO EROWSLrtiBLOCK TRACT q I1� EESGIZE OF LOT OWONLOT[ TEL NO -V77�US[ OFBUILDING. ICT NO OROUP MAP PROCESSED BY
eK POCONTRACTORADO.[ av �. CONNECTION DATA
CITY / /TEL NO 4/Sa 72 STATION D
STATE
NO Da _6V 5 L C — 1 MANHOLE REFERENCE ' UPPER
I
NO DESCRIPTION OF WORK FEL TYPE OFCONN[CTION 1 LENoiX FR
HOUS[.LWER CONNECTING TO Y CURB I L M L TOP L
PUBLIC SEWER $700
SEPTIC TA NK SEEPAGE PIT OA PC MO
PITS AND/OR DRAINFIELD 0 SIODO CO IMP NO —
HOUSPRIVA SEWER CONNECTING TO TAURK PERMIT NO ROAD PERMIT NO Y a
PRIVATE DISPOSAL SYSTEM C f500 �\ O
COMNCCTAODITIONALDWO OR AFFIDAVIT SMYI[ .......I RECORD INS" NO DAT{ if
WORK TO HOUSE SEWER fSOp
OVERFLOW SEEPAGE PIT DRAINFIELD O
E%TN C965FO01L DRYWLLL O 35M HWY ORST WIDENIXO r
ALTER REPAIR OR ABANDON HOUSE `J
SEWER OR DISPOSAL SYSTEM O SS 00 STAT[ENCROACHMENT 1y
MANHOLE O $7 00 PERMIT NO a
N
INDUSTRIAL Z
WASTE APPROVAL
O PERRDT 9 00 CXAROL6
AUTHORIZATIO TOTAL FEE CONNECTION CHARGE FEC
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON REIMBURSEMENT F![
TRACTOR TO CONNECT THE ABOVE DESCRISC L.41pTING DW{LLING
TO THE PUSLIC S[ APPROVALS O T[ 'NSP TORS ON,TURC
SIGNED THIS AY O 19�
OWNER OR NEW HOUSCSCWER
OWNERS AGE MT
CONNECT ADDITIONAL
ADOR[Ep
BUILDING ORRWORKWORN
BCPTICTANK SEEP PITISI
1 HERESY ACKNOWLEDGE THAT 1 HAVE PGD THIS AFFLICTION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED A6 REOUIRCD BY LOS ANGLES COUNTY A ID STAT[ OF e[WAGE DISPOSAL SYSTEM
CALIFORNIA OR TH,T AM TH[ LCO,L OWNER OF INTE O TO DI.CONNECT PLUG AND
RESIDE IN THE • [ [[CRI [D RESIDE AL ! ApAN DON NOUS6 SEWER
SIONATURE
OF PERMTTTC[ pACKFILL SEPTIC TANKS ❑
SEEP PITISI POOLS
VALIDATION cK M D CASH
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