HomeMy Public PortalAbout10614 FAIRHALL ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER i SEWER-SEWAGE DISPOSAL
DIVISION OF-BUILDING AND SAFETY PERMIT APPLICATION
COUNTY ON-LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ANG
DDREISS
FOR APPLICANT TO FILL IN LOCALITYBUILDING NEAREST
ADDRESS 10614 Fairhall St i CROSS ST. 0
LOCALITYTemple lilt DISTRICT NO. SERIAL NO. - / cPERMIT N0. cc
NEAREST A /�d �l.lf- SJ
CROSS ST. T:1 TrlOnt A Avg. RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P. L. boa Nutt
MAILUSE ZONE OCCUPANCY MAP
ADDRESS 272:t
SannGabriel Blvd. BK PG
CITY San Gabriel TEL-NO. AT 94364
CONTRACTOL. D. 8c-M. Cans-tr., Co. �CQiIl�1e.-[tlQ L.r� �Cy[
ADDRESS ,21 W. Wistaria Ave. JOB NO. � SS
CITY Arcadia TEL-N0. DO 62238STA
TRUNK PERMIT N0.
-REGISTRATION NO 11361.3 _�G��-2 - ❑ COUNTY
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT 2 CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DE 1 O ORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLIC SEWER @ $ 3.50 3 50 RECEIPT NO. I ATq� E 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 r'OATE 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 /
PITS AND/OR DRAINFIELD 2.00STATION DEPTH
CJ
CESSPOOL—DRYWELL �.�. !� .D
SPECIAL CONDITIONS ONLY 2.00 - / MANHOLE REFERENCE r V11
I+RHbR VV a-,-I LOWER-
TYPE OF CONNECTIONLENGTH FROM`
OWNERS PERMIT 1 -00 Y— (CURB P.L:'L�M.L.TO P.L. IS
AUTHORIZATION I TOTAL FEE ' 4 1 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 E] DRYWELL❑
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 I 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
SEEP.PIT(S)[:] CESSPOOLS[] ,
1
OF PERMITTEE.•.-L- :.-Dy--A..-M---�ouis iwu ..'
76A642D 663 1/53 A0�kjjxjAdi� � a I O�