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HomeMy Public PortalAbout10607 FAIRHALL ST_Sewer__ DEPAIVrMENT OF COUNTY ENGINEER I SEWER—SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY ! PERMIT APPLICATION" COTTNW OF LOS ANGELES ' WILLIAM J. FOX, COUNTY ENGINEER BUILDING I ADDRESS b 6 0'7 FOR APPLICANT.TO FILL IN LOCALITY !` � BUILDING NEAREST -� ADDRESSlOSQ7 Pairh2ll St. CROSS 8T. LOCALITY Temple City DISTRICT NO. SERIAL NO. PERMIT NO. NEAREST A /9s� -'�.Q S CROSS ST._E:1 b'lUYlt6 Age• _RECEIVED BY Ready for Inspection DATE ISSUED OWNER p.L. &IeNUtt / -/(, _ MAIL OCCUPANCY MAP ADDRESS 2'j2a Sfl.ri Gabriel. Blvd, I USE ZONE I n I BK PG CITYSan Gabriel TEL.NoAT 94364 /� {/��J�� CONTRACTOR L. �. &M. G©nstr. Co. COAMP-NO. t? �-7 - ADDRESS 21 W. Wistaria Ave i" JOB NO. 5 CITY Arcadia TEL.NO. DQ 6 2238 TRUNK PERMIT NO. STATE j REGISTRATION NO. 113613 C 42 LJ COUNTY ROAD PERMIT NO. LEGAL DESCRIPTION LOT NO. STATE ENCROACHMENT 2() PERMIT NO. BLOCK TRACT INDUSTRIAL 1:189 WASTE APPROVAL SIZE OF LOT N0.OF SLOGS NOW ON LOT 1 ,,CIiARGES USOF BUE DINGS ROS, CONNECTION CHARGE FE NO. DESCRIPTION OF WORK FEE \ HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE PUBLIC SEWER a $ 3.50S RECEIPT NO. DATE IBY HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM I.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO•/I DATE IBY SEWER OR DISPOSAL SYSTEM 1.00 DISCONNECT AND ABANDON SEWER _ AND/OR DISPOSAL SYSTEM . 1.00 C0*N.EG.T-IQN_DAT,A SEPTIC TANK,SEEPAGE PIT OR / PITS AND/OR DRAINFIELD 2.00 STATION Z d / O DEPTH Cp / CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 /3 s� C_My/UPPER REFERENCE ESR TYPE OF CONNECTItON �-LENGTH FROM �R$ P.L. M.L.TO J/ OWNERS PERMIT $ I 00 ' P.L. AUTHORIZATION TOTAL FEE Flo i I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVAL'S INSPECTOR'S SIGNATURE DATE I SIGNED THIS....................DAY OF.........................................14._._._ NEW HOUSE SEWER $C r- OWNER OR CONNECT ADDITIONAL OWNERS AGENT-.....----._--------------------------------------------------------------' BUILDING OR WORK ADDRESS..................... SEPTIC TANK,SEEP.PIT(S) - -....... - I AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL E] 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 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 SIGNATURE L I SEEP.PIT(S)� CESSPOOLS[:) OF PERMITTEE............-m--l4C .�a...�`(l7�tr '• ............. 76A642D 663 1/53 }�p