HomeMy Public PortalAbout10637 FAIRHALL ST_Sewer__ DEPAKT!►ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 7
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 1
COUNTY OF LOS ANGELES
WILLIAM J..,FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN �J,A LOCALITY -04BUILDING
NEAREST
ADDRESS / 3 7 � / CR SS ST
LOCALITY . DISTRICT NO SERIAL NO p�PERMIT NONEAREST
C
CR SS ST �, t- A 7t S°T ��J
RECEIVEDI BY Ready for Inspection DATE ISSUED
OWNER
MAIL /� (
ADDRESS „ �E ZONE I OC�ANCY I BK MAP PG
CITY TEL NO /� /' �� ��► a ' IY
CONTRACTOR CO=lM9_–NO '� (�
ADDRESS JOB NO 61 _6
CITY �J9�P�, TEL NO,, , ®, 4 �� TRUNK PERMIT NO
REGISTRATION NO /� ,�Q 4 COUNTY
= ROAD PERMIT NO
LEGAL
DESCR.PTION LOT NO A-61 L/ STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT INDUSTRIAL \
{
SIZE OF LOT NO OF BLDGS WASTE APPROVAL
dJ NOW ON LOT CHARGES,
USOF
BUELDINGS _ s .:� IAM drat, z�y_� CONNECTION CHARGE FEE /
NO DESCMIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOREIMBURSEMENT FEE
PUBLICSEWER @ $ 350 RECEIPT NO I DAT` IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 100
CONNECT ADDITIONAL BLDG OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1 00
ALTERR OREPAIR EXISTING NO DATE IBY
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 200 STATION 14 10, a DEPTH G ��
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 / MANHOLE REFERENCE r
C LOWER
TYPE OF CONNECTIONLENGTH FRO i
OWNERS PERMIT $ 1 00 Y m' "RU.. P L L_�M L TO P L 5
AUTHORIZATION I TOTAL FEE - lw
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 <•� , G>� x S�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ _ _ _ _ BUILDING OR WORK
ADDRESS _ _ _ _ _ SEPTIC TANK,SEEP PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL I] 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
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE SEEP PIT(S)[:] CESSPOOLS
OF PERMITTEE _ � � •_ d����
i t
76A642D 663 1/53 ��4 �} aJ ( 1