HomeMy Public PortalAbout9588 SPARKLETT ST_Sewer__ DEPAUTDD.NT OF COUNTY ENGDUMB SEWER-SEWAGE DISPOSAL 1
DIVISION OF Bummc; AND SA$ETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDIN
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESG
1
pp APPLICT�O •p/µ� 'yN�� LOCALITY
BUILDIADDRESS ////91� I/ ,y///n_� CRO88 ST
ADDRESS KKK",77a[ FFF/// --((CC» FrSSA'^�""��//"vl
LOCALITY r DISTRICT NO SERIAL NO PERMIT NO
NEAREST S—(�L+ A ;LS-3 ,3? S
CR088 8T
R=BY Ready for Inspection DATE ISSUED
OWNER
NAIL
AGGRESS USEZONE OCCUPANCY MAP
BK PO
CI TEL N
CONTRA 11
CO IMP NO
ADDRESS 108 NO
CITY TEL NO TRUNK PERMIT NO
REGISTRATION NO STATE
COUNTY ROAD PERMIT NO
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO PERMIT NO
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO OF SLOGS
NOW ON LOT CHAR S
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER GONNECTINS TO
PUBLICBEWER ® � 880 RECEIPT NO DAT BY
OUB SEWE CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDO OR EXCE ION RECO DED
WORK TO HOUSE SEWER 1 00 Q'd
ALTEROil REPAIR EXISTING N DATE BY
SEWER OR DISPOSAL SYSTEM 100
DISCONNECT AND ABANDON SEWER
AMD OS DISPOSAL SYSTEM 1 00 cANNECTION DA A
SEPTIC TANK,SPA E PIV OR
PITS AND/OR GRAINFIELD 200 STATION DE
RYWELL
SPECIAL CONDITIONS ONLY 200 MANHOLE REFERENC
UPPER LOWER
TYPE OF CONNECTION I PHOTO FROM
OWNERi----1 PERMIT f 1 1pi
Y CURB PL M L TO P L
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED,EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS — DAY OF_—_ __19 — NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ _ __ _� ___ _ __ BUILDINGORWORK
ADDRESS _ _ _ __ SEPTIC TANK.SEEP PIT(8)
AMD/OR GRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWEROR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OFC 1FORNIA OR THAT 1 AM THE LEGAL OWN. ABANDON HOUSE SEWER
EB OF THE AS BED RESIDE 1 PBOPE B FI TANK �T
SIGNATURE SEEP PIT(S)[] CESSPOOLS[]
OF PERMITT
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