HomeMy Public PortalAbout10600 FAIRHALL ST_Sewer__ DEPAItfMENT OF COUNTY ENGINEER ? SEWER-SEWAGE DISPOSAL
DIVZ$ION_=DF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING /
I ADDRESS
-"FOR APPLICANT TO FILL IN LOCALITY
BUILDING NEAREST ADDRESS 10600 Flafrhall St=. CROSS ST. °� V
LOCALITY Temple City DISTRICT NO. SERIAL NO.' PERMIT NO; c
NEAREST S A �� Z�`�0 J
CROSS ST. E1 Monte Ave� REQ,EIVEDBY Ready for Inspection DATE ISSUED
OWNERp.L. 1M('hT12t t
MAIL 1 USEZONE OCCUPANCY `MAP
ADDRESS72a San Cabr;ai R1 vrl, BK, PG
CITY SAA Gabriel TEL.NO,(aT 94,364 A
CONTRACTOR L• y• M. Constr. Co. 0oxi, No.
ADDRESS 21 W. Vit Stara' - lave• ., � S�—
JOB N0.
CITY Areadla TEL.NO. DO 6 2238 TRUNK PERMIT NO. C
4 STATE
RELEGAL GISTRATION N0113613 -0- 42 ❑ COUNTY ROAD PERMIT NO.
.�:p
DESCRIPTION LOTJd 18 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 91 INDUSTRIAL
E APPROVAL
0
SIZE OF LOT N0. BLDGS.
NOW ON LOT 2 CH6RGESUSOF
_
BUE DINGS Res. & Gare bge CONNECTION CHARGE FEE
N0. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE \
HOUSE SEWER CONNECTING TO 3 50
PUBLIC SEWER Q $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO /
PRIVATE DISPOSAL SYSTEM 1.00
"CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER -1.00 - -
ALTER OR REPAIR EXISTING NO. I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER -
_ AND/OR DISPOSAL SYSTEM 1.60 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION :_ t/ CD
DEPTH
CESSPOOL—ORYWELL T�•d
SPECIAL CONDITIONS ONLY 2.00 / / , MANHOLE REFERENCE
C 0%UPPER
TYPE OF CONNEC N (-/EENGTH FROM
OWNERS PERMIT $ I 00 �— etme- P.L., -M.L.TO P.L.
AUTHORIZATION I" TOTAL-FEE A 50
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........................................._..................................._ BUILDING OR WORK
---------------- SEPTIC TANK,SEEP.PIT(S)
ADDRESS------
•- ----------------- -------------•--------......--.......---- - AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE"THAT I HAVE-READ THIS APPLI- CESSPOOL DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWSALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REWSTEP.ED AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF-THE ABOVE DESCRIBED-RESIDENTIAL PROPERTY., BACKFILL SEPTIC TANKS
SIGNATURE L SEEP.PIT(S)E] CESSPOOLS E]
OF PERMITTEE-.._:. .:D!-. .--M - O/`�Q21Sia
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