HomeMy Public PortalAbout10601 FAIRHALL ST_Sewer__ DEPA1trNiENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
C0163NTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS /6 b
FOR APPLICANT TO FILL N _ 'X/ LOCALITY NEAREST
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BUILDING �� G G �� GCA/ I / �6G�' '• CROSS ST. �J .Q^^�
ADDRESS
LOCALITY 1j' DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST l/ �� + A c�sZc / q S
CROSS
CROSS ST. -,/(!L� �
OWNER
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MAIL
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CITY TEL.N0. r� �/�6
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CONTRACTOR G �rfZ l A' GO_rM•P'NO, CJ S
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CITY TEL.NO.
69"p-70 . TRUNK PERMIT NO.
REGISTRATION NO. j � -�� - COU'N/_7p-]c
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ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 9/�9 INDUSTRIAL
! WASTE APPROVAL
SIZE OF LOT N0.OF BLDGS.
NOW ON LOT ` I CHARbES
USE OF / \
BUILDINGS CONNECTION CHARGE FEE 1
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO �/ REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 J RECEIPT NO. I ATE _T
BY
HOUSE SEWER CONNECTING TO {
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPNON RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I I ATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 F CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR /
PITS AND/ORDRAINFIELD 2.00 STATION Z. f"SC � S DEPTH G
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.0012- / z M'/ANHO LE ER REFERENCE
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TYPE OF CONNE TION L_ LENGTH FROM f
OWNERS PERMIT' $ 1 00 1 04MB P.L. M:L.TO P.L.
AUTHORIZATION I TOTAL FEE
1 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
ADDRESS-------------------•-----.-------------------_-----•---------------- SEPTIC TANK,SEEP.PIT(S)
- - AND/OR DRAINFIELD
I 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 LAWS! ALTER, REPAIR,SEWER OR
REGULATIkG PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED, DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
j SEEP.PIT(S) CESSPOOLS -
SIGNATURE
ESSPOOLS -SIGNATURE ®� 0 e -�
OF PERMITTEE____---__-.._________......
76A642D 6153 1/53 '�i3�� �,///