HomeMy Public PortalAbout10665 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 BUILDING
ADDRESS /O(�
FOR APPLICANT TO FILL IN LOCALITY
BUILD' NEAREST
'10665 Fairball St.
CROSS ST. � #=t�
LOCALITY Temple Cit y DISTRICT NO. SERIAL NO. PERMIT NO.
CNEAREST
ROSS ST. El Monte Ave• � A � g L(�(�"�9 S
RE EIVE BY Ready for Inspection DATE ISSUED
OWNER P. L. McNutt
MAIL
-ADDRESS 2729* San Gabriel Blvd. USE ZONE OCCUPANCY MAP
- I BK PG
cIT.vSan Gabriel TEL.No. AT-S 94364 A o
CONTRACTOR L. D. gM, Constr. Co. O, ,r-,2,c , -) :�4
ADDRESS 21 TV. Wistaria Ave* /
JOB N0. (o
CIT',(Ar(;adia. TEL.NO. DO 6 238 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 113613 C 42 COUNTY ROAD PERMIT NO. �
LEGAL
DESCRIPTION LOT NO. .?9 STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT 2. CHARGES
USE OF Res• & Garage
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLIC SEWER @ $ 3.50 3 50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PR2VATE DISPOSAL SYSTEM 1.00 A�
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE_'�-s 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 STATIONDEPTH
/ y C�
CESSPOOL—DRYWELL a
SPECIAL CONDITIONS ONLY 2.00 M NHOLE UPPER REFERENCE
TYPE OFCONNEC�_ION _LENGTH FROM S Ste/
OWNERS PERMIT $ I 00 N1 CURB- P.L. M.L.TO P.L. S
AUTHORIZATION I TOTAL FEE 4, 50
I 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.............._._._......:...........I9..._._ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT------------------------ ---------------------------------------------------- BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS-----------------------_-------------------- -------------.-- .................. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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
1 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 E:]
SEEP.PIT(S)❑ CESSPOOLS❑
SIGNATURE
OF PERMITTEE-lis...D-s__.L4G-_ ..._GQYla^ xY!�--(yg�.........--......
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