HomeMy Public PortalAbout10604 FAIRHALL ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISIOY__OF BUILDING AND SAFETY
PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
WILLIAM J. FOX, COUNTY ENGINEER tI ADDRESS d �o � �' �Av
FOR APPLICANT TO FILL IN I LOCALITY � C a
BUILDINGA �� ! / ` , NEAREST-DDRESS (,� 'y CROSS ST '�-��)n(! �:✓�
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LOCALITY F DISTRICT N0. SERIAL N0. PERMIT N0.
NEAREST �p : A
CROSS ST. � f
OWNER RECEIVED/BY Ready for Inspection DATE ISSUED
MAIL
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ADDRESS a. lip ll --X/f a USE ZONE OCCUPANCY MAP
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CITY TEL.NO. ry7_ C1y�< A m /
CONTRACTOR / CO-.LMP_;-NO'.
ADDRESS fv -zv�ew''L `�'"� JOB NO.
CITY TEL.NO. �, �j TRUNK PERMIT NO. _
REGISTRATION NO. /� �y /�' C" p=SCaFFNTY
ROAD PERMIT N0.
LEGAL `
DESCRIPTION LOT N0. / STATE ENCROACHMENT \)
PERMIT N0.
BLOCK TRACTDUSTRIAL
I WASTE APPROVAL
SIZE OF LOT N0.OF BLDGS.
NOW ON LOT CHARGES
I USE OF �/ \
BUILDINGS _ "'z— CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE g' \
HOUSE SEWER CONNECTING TO �� REIMBURSEMENT FEE
PUBLIC SEWER S 3.50 J Ci RECEIPT NO. I DATE I BY
HOUSE SEWER NE
CONCTING TO /
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER 06REPAIR EXISTING NO. I -_—DA- E I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
,AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR ss
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH Cp
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 q�j L��ff O MANHOLE REFERENCE
]i1�[!� (: d`J UPPER 4:024E:R
TYPE OF CONNECTION LENGTH FROM !
OWNERS PERMIT = 1 00 _Y: 'CITRB- P.L. L.— M.L.TO P.L.
AUTHORIZATION TOTAL FEE Z7� 3-0,
IHAVE 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 1 HAVE READ THIS APPLI. CESSPOOL[-] DRYWELL ED
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 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 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE SEEP PIT(S)E3 CESSPOOLS 0
OF PERMITTEE_-.__.----.r..r�G"''a /' r✓l�I�_^'�y,��`� �P
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