HomeMy Public PortalAbout10632 FAIRHALL ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
1 ADDRESS
FOR APPLICANT TO FILL IN I LOCALITY
BUILDING '///S Q.^16Cn � rL'C NEAREST 1
ADDRESS '/ c�®( GIA�I CROSS ST
LOCALITY I_ _ �— DISTRICT NO SERIAL NO p PERMIT NO
NEAREST S A F S�L �C f 3
CROSS ST
OWNER , / sdaZ�TsY RECEIVED BY Ready for Inspection DATE ISSUED
MAIL
ADDRESSN� , � � USE ZONE OCCUPANCY MAP
I A - � I BK PG
CITY TEL NO e? -?,/,
A -
CONTRACTORA� CO;-IMP-.NO
C-/-
ADDRESS -7i(f � JOB NO 45- 5—
CITY
SCITYTEL NO TRUNK PERMIT NO
REGISTRATION NO 11-3 'C:2- �IV M=ly-
ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO / STATE ENCROACHMENT
BLOCK TRACT PERMIT
INDUSTRIAL
NO OF BLDGS WASTE APPROVAL
SIZE OF LOT NOW ON LOT CHARGES
USOF
BUILDINGS �
CONNECTION CHARGE FEE
NO DESCRIPTION OF WORK FEE G REIMBURSEMENT FEE
! HOUSE SEWER CONNECTING TO
PUBLICSEWER Q $ 350 RECEIPT NO I _DAT' --�/71 BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTER 01 REPAIR EXISTING NO I DATE BY
SEWER OR DISPOSAL SYSTEM 1 00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR f
PITS AND/OR DRAINFIELD 200 STATION (l 4.� �� DEPTH
CESSPOOL—DRY W ELL
SPECIAL CONDITIONS ONLY 2 00 ��/ MANHHOLL�E�REFERENCE LOWER
- TYPE OF CCORNNECTIONP L VrLENGTH
p FROM
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE A/ ]WS
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NA
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISAPPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS DAY OF 19NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT - BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(S)
AND/OR DRAINFIELD
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS ACESSPOOL DRYWELL
CATIONAND STATE THAT THE ABOVE IS CORRECT AND ATO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LALTER REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS SEWAGE DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTDISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL EROF THE ABO`VEDESCRIBED RESIDENTIAL PROPERTYBACKFILL SEPTIC TANKS
SIGNATURE7 SEEP PIT(S)� CESSPOOLS
OF PERMITTEE -
76A642D 663 1/53 ���