HomeMy Public PortalAbout10649 FAIRHALL ST_Sewer__ r
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
OF BUILDING AND SAFETY ' PERMIT APPLICATION
• COUNTY OF LOS ANGELES
WILLIAM J FOX, COUNTY ENGINEER I BUILDING
ADDRESS IO
FOR APPLICANT TO FILL IN LOCALITYBUILDING NEAEST
S�
ADDRESS 10649 Fairhall St. CROSS ST I 1
LOCALITY Temple City DISTRICT NO w SERIAL NO PERMIT NO c
CNEARESTROSS ST Al Monte Ave• A ���� �rZ'�S
RECEIVED BY Ready for Inspection DATEISSUED
OWNER p", MR
MAIL 1 USEZONE
ADDRESS 272x- San Ga.hriel Blvd, OCCUPANCY MAP BK PG
CITY San Ga.brile TEL NO AT 94364
CONTRACTOR Ta Da &, R46 Cpymtro Cp, CC,O,IMP.sNO
ADDRESS 21 'Y• Wis taria Ave. JOB NO 5-5
CITY Arcadia TEL NO 1)0 62238 TRUNK PERMIT NO
Jh STATE
REGISTRATION NO ll 8613 r 42 ❑ COUNTY ROAD PERMIT NO
LEGAL
DESCRIPTION LOT NO 26 STATE ENCROACHMENTPERMIT NO
BLOCK TRACT 19189 INDUSTRIAL
NO OF BLOCS WASTE APPROVAL
SIZE OF LOT NOW ON LOT 2 CHARGES
USE OF
BUILDINGSCONNECTION CHARGE FEE
NO DESCRIPTION OF ❑RK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLIC SEWER @ $ 350 3 .50 RECEIPT NO I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1 00
CONNECT ADDITIONAL BLDG OR EXCEPTION CORDED
WORK TO HOUSE SEWER 100
ALTER OR REPAIR EXISTING NO I TE 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 200 STATION f `L�, DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 200 (� `N UPOLE PER REFERENCE
TYPE OF CONNEQf ION ``M LENGTH FROM
OWNERS PERMIT $ 1 00 - - es�8- P L L TO P L
AUTHORIZATION I TOTAL FEE
1 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 SC1 G a 022 S,3
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❑ DRYWELL
'AT
IONAND 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 ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFI LL SEPTIC TANKS❑
SEEP PIT(S)E] CESSPOOLS E]
SOF PERMITTEEL• Di M• -QQjj gtr.
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