HomeMy Public PortalAbout9843 FLAHERTY ST_Sewer__ DEPARTMENT OF COUN'T'Y ENGINEER, �•� SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER j I_ADDRUILDESS �Q �� j ���L, vCJ/•
FOR APP ICA N TO. F INBUILDING NEAREST
LOCALITY_ / � `
ADDRESS CROSS ST. _�QGl� s� 12s"�5
LOCALITY DISTRICT N0. " A .SERIAL NO. PERMITJ
NO. C
NEAREST A 270e-10
CROSS ST. EC n •
RI Y Ready for Inspection DAT ISSUED
OWNER
ADDRESS MAIL
/ f / USE ZONE OCCUPANCY AP
,rBK PG
CITY L.NO. _ � � ��� ` �6
CONTRALTO CO.IMP.NO.
ADDRESS 4 JOB NO. �1
CITY TEL.NO. Ve ®v TRUNK PERMIT NO.
ATE
REGISTRATION N0. �� COUNTY ROAD PERMIT N0. -74
LEGAL DESCRIPTION LOT NO. l STATE ENCROACHMENT
PERMIT NO,
BLOCK TRACT 4 : INDUSTRIAL
WASTE-APPROVAL
SIZE OF LOT I NO.OF BLDGS. CHARGES
N WON LOT
USE OF
BUILDINGS CONNECTION CHARGE E"'
NO. DESCRIPTION OF WOR -FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 RECEIPT NO. TE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 -
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECO ED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. ( DATE BY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA _
SEPTIC TANK,SEEPAGE PIT OR 1Q .DEPTH
PITS AND/ORDRAINFIELD 2.00 STATION L5 /'-�y S
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.007 MANHOLE_REFERENCE r '
,,J . -U99ER- <L
TYPE OjGONECTION LENGTH FROM
OWNERS PERMIT ; 1 00 y C cuRE M.L.TO P.L.
•. AUTHORIZATION I TOTAL FEE 1
/I }
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INS PECTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWE�
-
SIGNED TH1 .
IS.___...�_...____.DAY OF_-_ � � >"{ NEW HOUSE SEWER
T CONNECT ADDITIONAL v
OWNER' OR -
OWNERS AGENT... __3. ^_ - BUILDING OR WORK
- � --- - SEPTIC TANK,SEEP.PIT(S) '` •
ADDRESS .� may___._._.. �o._;---------- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT'I HAVE READ THIS APPLI• CESSPOOL[] DRYWELL E]
CATIONAND 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 LOS'AN ELES COUNTY ABANDON HOUSE SEWER
,AND STF CA OR OR A �iL•EGj1L OWN-
ER TA
OF THEE AOIF
BOV E BED. IDE POP RTY. PACKFILLSEPTIC TANKS
�
a SEEP.PIT(S) CESSPOOLS
SIGNATURE
OF PERMITTEE...
76A642A' 663 7/53F
ci
s.,