HomeMy Public PortalAbout9866 FLAHERTY ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES _
WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS �(� ?
FORBUILDIN /APPLICANT TO FILL IN /y LOCALITY 7'_� 10 Cl y
ADDRESS C� �X g/7 � / NEARESTCROSS ST. //Wo
LOCALITY Tz-- �y��>��- ,�'/� T DISTRICT NO. SERIAL NO. / PERMIT NO.
-NEAREST CROSS ST. //—�D /�D.L Ir L /��S� A 4�" P 4 ✓` 2 7 S
RECEIV D 9Y
j Ready for Inspection DATEISSUED
OWNER
MAIL r- / �� USE ZONE OCCUPANCY MAP
ADDRESS I BK PG
CITY T�^ TEL.NO.�� �� `,��
CONTRACTOR
CO.IMP.NO
ADDRESS
JOB.N0.
CITY TEL.NO. TRUNK PERMIT NO.
F] STATE
REGISTRATION NO. ❑ COUNTY ROAD PERMIT NO.
LEGAL �� STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT ® ;P INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTNO.OF BLDGS.
® X �® NOW ON LOT, CHARGES
USE OF �•'
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTIO OF WORK ' FEE 1.4REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO py y
L PUBLICSEWER @ $ 3.50 I RECEIPT NO. yl�%r DATE (B
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 j✓ N0. I
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM L00 DATE BY
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 I STATIONDEPTH
SPECIAL CONDITIONS ONLY 2.00
` > ® MANUHOLE PPER REFERENCED
TYPE OF CONNECTION LENGTH FROM q
OWNERS PERMIT ; I ( P.L. M.L.TO P.L. Ld
AUTHORIZATION 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.PUBLIC SEWER
SIGNED THIS.---- ^7 /.� NEW HOUSE SEWER
................ 19--•---__....-_...........19 _
r _
OWNER OR.,-- %� r ANNECT ADDITIONAL
p BUILDING OR WORK
OWNERS AGENT.:-•--- '`-�- ...........
• --
✓ SEPTIC TANK,SEEP.PIT(S)
ADDRESS.............•---_--•- .................................-........................... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE REAd HIS APPLI- CESSPOOL[:] DRYWELL
CATION AND STATE THAT THE ABOVE IS COR CT 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 1 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. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S)[] CESSPOOLS
OF PERMITTEE—'------• ....... ... ... ............................
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