HomeMy Public PortalAbout10620 FAIRHALL ST_Sewer__ DEPAItrMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDIN
ADDRESS/
FOR APPLICANT TO FILL IN LOCALITY
LOCALITvBUILDING
NEAREST
ADDRESS �Q —t4 /���Ldt�/ CROSS ST. �K�1.✓..p�- � ��
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. C
NEAREST ) A 1 q 6-Z�f ' S-/
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNERMAIL
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RESS ��� - USEZONE OCCUPANCY MAP
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CITY � TEL.NO.
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CONTRACTOR ' .
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ADDRESS `S JOB N0. lq J
CITY �O /�i�lA TEL.N0.� Q . `p1�' 3� TRUNK PERMIT N0.
RELEGAL GISTRATION NO. )/,7(//`7—(—Y� H-CO41TT-Y
/
ROAD PERMIT N0.
DESCRIPTION LOT N0. f / STATE ENCROACHMENT
/ �j PERMIT NO.
BLOCK TRACT l �/ 7 WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS � ��.- ��'�.e CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE 41
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ S 3.50 RECEIPT NO. DATE 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 NODI-- DATE. 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 2.00 STATION O.7L 6 T. o DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE 1A/
7 J�P_P_ER Vy LOWER
TYPE OF CONNECTION `_[:ENGTH FROM
OWNERS PERMIT $ 1 00 Y. O"•RB- P.L. M.L.TO P.L. I +J
AUTHORIZATION TOTAL FEE /V 1'd
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
DWELLCONTRACTOR
TCONNECT
THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS-------_-----------DAY OF................................_......19........ , NEW HOUSE SEWERcJG
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..........................................................................•.. BUILDING OR WORK
ADDRESS
SEPTIC TANK,SEEP.PIT(S)
-............................................................... - 1 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
I HEREBY CERTIFY THAT I- AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY I 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)E] CESSPOOLS❑
OF
76A642D 663 1/53