HomeMy Public PortalAbout9837 FLAHERTY ST_Sewer__ 76AG42D ,
SaE-6633.55 APPLICATION - FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DIS POSH L, -
Deportment of County Engineer
County of.Lds Angeles BUILDING
WM.J. FOX, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY M—_ L
FOR APPLICANT TO FII.L IN NEAREST ' G7
CROSS ST.
LEGAL r
DESCRIPTION LOT N0. OWNER ��i/1.�-415
BLOCK TRACT / MAIL = {T
ADDRESS
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SIZE OF LOT c/) NOWOONBLOTS CITY G'!✓L-a te TEL. NO. I-3 '
USE OF p
BUILDINGS L+f .16 DISTRICT NO, GROUP MAP PG
BK
CONTRACTOR -7 •� (/C. C I I L IR p�
ADDRESS3 s�•;� CONNECTION DATA / tf
CITY "/ TEL. NO Lv STATION a — f DEPTH 4B
STATE MANHOLE REFERENCECY,,ef/ 4S-7
REGISTRATION NO. ❑ COUNTY LOWER
No. DESCRIPTION OF WORK FEELNTH FIR
�7
HOUSE SEWER CONNECTING TO
Y. TYPE CURB/
PUBLIC SEWER @ $ 3.50 POE OTjl,E CTIOP L. MEL GTO P LOM C� L—
'��
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG. OR -•�sil
WORK TO HOUSE SEWER 1 00 CO. IMP NO. �f/JOB NO.
ALTER OR REPAIR EXISTING TRUNK PERMIT NO. ROAD PERMIT NO.3*57 ��
SEWER OR DISPOSAL SYSTEM 1.00 _
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK. SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL
WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
OWNERS PERMITS 1 00 CONNECTION CHARGE FEE
AUTHORIZATION- TOTAL FEE REIMBURSEMENT FEE
IHAVE TRACTORTO DATE CONNECT THEAABODVEWITH THE DESCRIBEDH EXEIN STINGA DWELLING APPROVALS INSPECTORS SIGNATURE
TO THE PUBLIC SEWE - -
SIGNED THIS DAY Ort/"' 19� NEW HOUSE SEWER
- � � /,STN/' 'Z�V.(L•
OWNER ORi CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK'
SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT. I.-HAVE READ THIS APPLICATION CESSPOOL ElDRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER.
DESCRIBED RESIDENTIA�eROPERTY. BACKFILL SEPTIC TANKS❑ �{��,,/�� �(�
<;j,
SEEP. PITS) ElCESSPOOLS
SIGNATURE `
OF PERMITTEE - •• - -
WILLIAM J.FOX.COU ENGINEER � ALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
Co 3 1 1 APR23 4 4.5