HomeMy Public PortalAbout10613 FAIRHALL ST_Sewer__ DEPAICTMENT OF COUNTY,ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
I ADDRESS 3
FOR APPLICANT TO FILL IN LOCALITY
BUILDINGO / '? EA REST
ADDRESS h j •�Qi CRO SST. \J
LOCALITY _ DISTRICT NO. SERIAL NO. PERMIT NO.
CROSS ST. A /y ���.,�� S
RECEIVED BY Ready for Inspection /DATEISSUED
OWNER '` 40 `V 1
MAIL /� �?�
ADORES ��'(` � USE ZONE OCCUPANCY MAP
BK PG
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CITY TELO. A `I
CONTRACTOR 7 '' �i 0071'MT'.NO. V C '1-•7`', 74
ADDRESS JOB NO.
Y/ �7
CITY +r�e" TEL.NO. { �fd TRUNK PERMIT NO. C
RELEGAL GISTRATION N0. �� f�" Com`� p=COUILE
ROAD PERMIT NO.
DESCRIPTION LOT N0. 52/ STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT G�%/�q INDUSTRIAL
r
SIZE OF LOT NO.OF BLDGS. WASTE APPROVAL
USE OF NOW ON LOT CHARGES
BUILDINGS o��_
�/'/�/�°"'"trQ� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO v REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 U - • RECEIPT NO. I DATE IBY
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 __ -D'ATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1-00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION +SD, p DEPTH' r
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 S�i MANHOLE
OER REFERENCEUPPR
TYPE OF CONNECTION LENGTH FROM /
OWNERS PERMIT $ I 00 Y- -CURB- P.L.4"P M.L.TO P.L. S
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED_
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS--------------------DAY OF.....................................19--•_.. NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OW N ERS AGENT...........-............--------------------------•-------- BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS - - - - - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[] DRYWELL I]
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 HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]
1 /��,���-/}� SEEP.PIT(S)E] CESSPOOLS❑
SIGNATURE o� ,� QA�
OF PERMITTEE-----------•--•----------------_-
76A642D 663 1/53
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