HomeMy Public PortalAbout9874 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 ENGINEERI BUILDING
CASSATT D. GRIFFIN, SUPT OF BUILDING ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
ADDRESS Z � f 0 . s .i�"�°` "$BUILDING NEAREST
CROSS ST.
LOCALITY /�` DISTRICT NO. SERIAL NO. PERMIT NO.
.moi A
NEAREST t -- + _
CROSS ST. Wit' Rr+�r,�vj`:�T a RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
USE ZONE OCCUPANCY BK MAP PG
ADDRESS
CITY TEL.NO.
CONTRACTOR CHARGES REIMBURSEMENT FEE
ADDRESS 4e
REQUIRED -
NOT REQUIRED
CITY �h TEL.NO. JOB NO. CONNECTION CHARGE FEE
STATE CO.IMP. NO.
REGISTRATION NO. J" COUNTY
LE;AL RECEIPT NO. DATE I BY
DESCRIPTION LOT NO.
BLOCK TRACT WAIVER FOR RECORDING
SIZE OF LOT NO.OF BLDGS. RECEIPT NO. DATE BY
NOW ON LOT
USE OF j
BUILDINGS i�2,�.-2 `L f� .
TRUNK PERMIT NO.
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
PUBLIC SEWER @_$ 3.50
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSAL SYSTEM 1.00 I PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 STATION DEPTH
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 MANHOLE REFERENCE
CESSPOOL—DRYWELL UPPER LOWER-
SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ I 1 00 —
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE WITH THEAED
CONTRACTOR TO CONNECT THTE ED ABOVE D SCRIBEDIEXIISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
,�{, c " , , NEW HOUSE SEWER
SIGNED THIS.. - .-'._DAY OF -
-----------------I 19-- —
OWNER OR ,' CONNECT ADDITIONAL
OWNERS AGENT. ... +���.V BUILDING OR WORK
– -
• SEPTIC TANK,SEEP.PIT(S)
ADDRESS___ .___ --_. ......__....;,-f_-... AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E:] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I 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. BACKFILL SEPTIC TANKS
SIGNATUREL�J.,�' h� 2 SEEP.PIT(S)0 CESSPOOLS
OF PERMITTEE- .--�I--YY--1i--� ------------------
76A642D 663 12/52,•