HomeMy Public PortalAbout9855 FLAHERTY ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
BUILDING
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS 4/*- � G
FOR,,,APPLICANT TO FILL IN LOCANEAREST
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BUILDING
ADDRESS CROSS ST. 61�
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U DISTRICT 0. SERIAL NO. PERMIT NO.
LOCALITY �14" 01/57�'p A �J'TNEAREST
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CROSS ST. �.� �i
RECEIVED--b Ready for Inspection DAT ISSUED
OWNER
MAIL ���� USE ZONlE� OCCUPANCY
ADDRESS BK PG
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CITY s, TEL.NO. Q �j�_S
CONTRACTOR � �19 o 15��� I� CO.IMP. NO. 3 3
ADDRESS � o� JOB NO.
TEL.NO. �3t � TRUNK PERMIT NO.
ATF
REGISTRATION NO. 00A3,0 if COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT N0,
BLOCK G TRACT Z 4 40(6 ` INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTg�r® NOW N0.OFONLBLOTDGS. CHARGES
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USE OF � � P
BUILDINGS P�/ CONNECTION CHARGE F E
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXC •TION ECORDED
WORK TO HOUSE SEWER 1.00 NO.
ALTER OR REPAIR EXISTING DA E ( BY
_SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR 4 � Y
PITS AND/ORDRAINFIELD 2.00 STATION fn �" DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ® AN EFERENCE /,�
��.x �bPPER , /�
TYPE OF CTION LENGTH FROM
OWNERS PERMIT $ I 00 a cuff M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED-WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P BLIC SEWER
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SIGNED ._DAY OF._...___0—d......___._....19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
BUILDING OR WORK
OWNERS AGENT._...
ADDRESS.____.--1.______. �...--_ _'..___-_V.0_ 6".__ -._-_• SEPTIC TANI(,SEEP.PIT(S)
—! - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI. CESSPOOL Ej DRYWELL 0
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 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESC BED RESIDEN IAL PRO ERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)� CESSPOOLS eye — g—
SIGNATURE
OF PERMITTEE
76A642A 663 7/53 t.