HomeMy Public PortalAbout9319 SPARKLETT ST_Sewer__ 76A i D '° APPLICATION FOR PERMIT
TBABsaD
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPRIiTN1EN7 OF COUNTY ENGQiEEB
BUILDING AND SAFETY DIMION
EURDIG
AbUl Coun ADO.0 91
BuP
WLALTmsm
of =V
LOCALITY
NEAREST
FOB APPLICANT TO FILL IN CRO[R 8T
LEGAL
DESCRIPTION LOT NO OWNER
NAIL
BLOCK TRACT AOORfi[S
XO 01 OLD68
SIZE OF LOT NOW OM LOT CITY ! TEL NO
USE OR
BUILDING[ DISTRICT NO ORO �Tp MAP PROCESSED BY
PO
CONTRACTOR � , b I K �Q
ADDRESS CONNECTION DATA
CITY / TEL HO �TzSTATION DEPTH
STATE MANHOLE REFERENCE
REGISTRATION NO D COUNTY LpW[q
No DESCRIPTION OF WORK Pi[ TYPE OP CONNECTIo L 4TH
HOUSE SEWER CONNECTING TO Y CURB P L M L TO
PUBLIC B[W[R O iS pO
SEPTIC TANK SEEPAGE PIT CA PC NO K
'ITS ANO/OR GRAINFIELD Y SIO Op CO IMP NO JOB NO
HOUSE$EWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM 8 [S Go
CONNECT ADDITIONAL BLDG OR TA"IDAVIT YNiu [.ViYMT RECORD INSTR NO DAT[
WORK TO HOUR[SEWER Y 13M y
OVERFLOW SEEPAGE PIT GRAINFIELD
ECTN CESSPOOL ORYWELL MANHOLE* [BOO ST WIDENING
SEWER OR DISPOSAL SYSTEM * iB 00 CROACHMENT
OAL
PPROVAL
•VNCHAR [[OTY+Ycii�s pEA(�I' f 2
AUTHORIZATION TOTAL FEE CONNECTION CHARD[FEC
I
HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON L�IAD
EMENT F[[
TRACTOR TO CONNECT THC ABOVE DESCRIBED EXISTING DWELLINGp
TO THE PUBLIC [EWER ROVAIS DAT[ INSPECTOR S SIGNATURE
SIGNED THIS DA$ OF //, iR_
OWNEROR �/(�fjQ / E SEWER
OW NERB AGENT '��[- �kL �' ADDITIONAL
OR WOgKADDRESSNK BSEP PIT(8)IHEREBY ACKNOWLEDGE THAT 1 HAV[ READ THIS APPLICATION tAINFI[LDAMDSTATE THAT THE ABOVE IE CORRECT AND AGREE TO COMPLYWITHALL COUNTY ORDINANCES AND STAT[ LAWS REGULATINGPLUMBING AND SEW ERE ❑ ORYW[LL ❑
HCRbY CERTIFY THAT AM PROPERLY ST EO AMD/OR [RR SCW[fl OR 1
LICENSED AB RQOUIREp LOB AN LINTY ANO STATE OPBSWAMLQM�-—I
CAIIfORNIA OR THAT TNC LCO O R OF ND IN TO DISCONNECT PLUG ANO
RESIDE IN TX[ O EBCRIBCD CSI N AL EI(TY ABANDON HOUE[SCW CR
iIOXARC ' BACKFILL B[PTIC TANKS ❑
OF T.R.P
BE PIT(B) ❑ CEfBPOOLS
ATIO ROBERT A WOOD
CK M o CASH SUPERVISING MECHANICAL ENGINEER
LtLo8 4 2 6G lZ 5 1 0 D 5.00" ,
%ye�