HomeMy WebLinkAboutUntitled JOB ADDRESS
OPE ld . Co+Q°h r PC> R. 6, ,.0144
NUMBER STREET
APPLICATION FOR A
SEWER - STREET CUT
OR
1„�'URB AND SIDEWALK �4)
�, BUILDING II SAFETY DIVISION /�/may±
L CITY OF ARCADIA, CALIFORNIA (.�V
OWNER TEL NO.
MAILING A DRESS 4
/6, 2 Cc rt al)c.) .D �
CO RACTOg 0 ® 1 c STATE .. NO.
MAI IN ADDRESS CITY LIC. /
CS Ofc c c 1 L A g e, GG4-
CIP( C TEL. NO
PERMISSION IS HEREBY GRANTED TO MAKE SEWER CONNECTION
AT
LOT BLOCK TRACT
Y
LOCATION LATERAL
SADDLE
SEWER PLAN NO. CESSPOOL FILL
$3 00 $
INSPECTED 197
TOTAL
BY BY $
ALL CONNECTIONS MUST BE INSPECTED BEFORE BEING BACKFILLED.
24 HOURS NOTICE REQUIRED.
CURB AND SIDEWALK
--rCTFTI gif'A K FEE
by
/ DRIVEWAY APPROACH $ / CA ve9
L CURB BREAK & DRIVEWAY APPROACH
SIDEWALK FEET REPLACE CURB
CURB 8 GUTTER FEET
CURB, GUTTER & SIDEWALK /F
A' R LZERIN7 @NDENT
ALL WORK DONE UNDER THIS PERMIT MUST HAVE INSPECTION BY THE
STREET SUPERINTENDENT
AMOUNT OF DEPOSIT
@1.50 PER SQ. FT.
ESTIMATED SIZE OF PATCH AMOUNT CHARGED
@1 50 PER SQ. FT.
ACTUAL SIZE OF PATCH AMOUNT REFUNDED
RECEIVED FROM STREET DEPT.
INSPECTION FEE
1
10.00
19 BY
PERMIT FEE
5.00
TOTAL FEE
X
SIGNA}KE OF CONTRACTOR OR AUTHORIZED AGENT .41110,
CONSTRUCTION PROHIBITED BETWEEN 7:00 P.M. AND 7:00 A.M.
AND ON SUNDAYS AND HOLIDAYS AS PER ORD. #1321. (i L
Z
INSPECTION RECORD
• RTIAL OR MISC. INSPECTIONS
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