HomeMy Public PortalAbout10653 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
ADDRESS
FOR APBUILDINGPLICANT TO FILLLOCALITY
, IN 4 �
NEAREST
ADDRESS �, � �,/,/ �lti CROSS ST r v
LOCALITY � � � DISTRICT NO A l�
SERIAL NO PERMIT ERM�N
�
NEAREST 7 J
C
CROSS ST d'tof'. -{l su RECEIVED BY Ready for Inspection DATE
ISSUED
OWNERMAIL
ADDRESS 49��y /�� USE ZONE OCCUPANCY BK MAP PG
CITY TEL NO /1;1,
i
CONTRACTOR
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ADDRESS �� J,el d"�O" ' JOB NO 5
CITY _ TEL NO C), 14l' 1 TRUNK PERMIT NO
REGISTRATION NOSTAT; ROAD PERMIT NO \
LEGAL
DESCRIPTION LOT NO7 ; STATE ENCROACHMENT
PERMIT NO
BLOCK TRACT � , � INDUSTRIAL r
MO BF BLOGS WASTE APPROVAL
SIZE OF LOT r NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE )
NO DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE r
PUBLICSEWER Q $ 350 C.i RECEIPT NO I DAT 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 Dg E I BY
SEWER OR DISPOSAL SYSTEM 1 00 1
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1 00 CONNECTION DATA
SEPTIC TANK SEEPAGE PTS AHD/OR DRAINFIIELDIT OR 200 /
STATION DEPTH
CESSPOOL—DRYWELL -�-
SPECIAL CONDITIONS ONLY 200 / MANHOLE REFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM
—
OWNERS PERMIT $ 1 00 , lv_ ebWB P L LSM L TO P L
AUTHORIZATION TOTAL FEE
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
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT _ _ _ _ BUILDING OR WORK
ADDRESS _ _ _ _ - - AND/OR DRAIPIT(S)
NFIELD
I HEREBY ACKNOWLEDGE THAT i HAVE READ THIS APPLI- CESSPOOL 0 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 ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY BACKFILL SEPTIC TANKS
SIGNATURE ® �. 1 ��, SEEP PIT(S)� CESSPOOLS
OF PERMITTEE _ _ :yyy «`
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