HomeMy Public PortalAbout9886 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 f l
ADORE ING
SS ( 6
FOR APPLICANT TO FILL IN
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EAREST
ADD EISS ( ,�'•._ CROSS ST.
LOCALITY ✓ DISTRICT NO. SERIAL NO. PERMIT NO.
NST .
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ROSS OSSST.e,,:F„r�` J�q�� R/E,CE/IV/ED BY' Reedy,forInspection DATE ISSUED _
OWNER
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ADDR ! ,�. USE ZONE • - OCCUPANCY MAP
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CITY �'�-"' TEL.NO. ✓ �
CONTRACTOR COO MP.NO...
ADORES � 3 _ JOB.NO.
CI ENO 1.-' TRUNK PERMIT NO.
1' ST TE
I REGISTRATION NO: ,� 0 COUNTY',
ROAD PERMIT N0.
i LEGAL ! STAT•EENCROACHMENT ^`� i
DESCRIPTION LOT N0. + PERMIT NO.
BLOCK TRACT-"� �� ' I INDUSTRIAL
��. +� WASTE APPROVAL
SIZE--OF LOT NOW ON LOTS / CHARGES
USE OF
BUILDINGS, //"� rL��.��s".m i �� CONNECTION CHARGE FEES+
N0. _DES:CRIPT.ION -OF• WORK . FEE-' ,-.HOUSE SEWER SEWER CONNECTING.TO =REIMBURSEMENT FEET.`~
PUBLIC SEWER Q $ 3.50 ��.� RECEIPT NO. AT �
/t1E BY
/ - HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM" 1.00
CONNECT ADD1T10NAL BLDG.OR "EXCEPTION RECORDED', .
WORK TO HOUSE SEWER 1.00 NO.
ALTER OR REPAIR EXISTING DATE` BY
SEWER OR DISPOSAL SYSTEM 1.00'I �
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE-PIT OR �-
PITSAND/OR DRAINFIELD 2.00 STATION / yL 1 DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCj
1LP�P�R LOWER 1_
TYPE OF CONNECTION ',LENGTH-FROM,�7
�. CUBS. P.L. M.L.TO P.L.
OWNERS ' PERMIT $ I '1 00 _
AUTHORIZATION = TOTAL FEE
I HAVE THIS�DATE-CONTRACTED,WITH THE 'HEREIN'NAM,ED
CoNTRIrVNR TO CONNECT THE'ABOVE DESCRIB XISTLNG '-APPROVALS INSPECTOR'S SIGNATURE- DATE
DWELLING TO THE PUBLIC SEWER
�E/�^` _ i
SIGNED S--------•-------_ Y OF.�.`.�!................ .�__-.-- --..... NEW HOUSE SEWER
OWNER OR
CONNECT ADDITIONAL-
OWNER
AGER BUILDING OR WORK
a- _ - - - -d SEPTIC TANK,SEEP.PIT(S)
A D D R ESS /..- - -= ------•------------------------------------------ AND/OR D RA I N F I E LD
I H EBY/ACKNOWLEDGE-THAT I HAVE READ THIS APPLI• CESSPOOL[] DRYWELL
CAT NAND STATE THAT THE'ABOVE IS CORRECT AND AGREE
TO OMPLY WITH ALLoCOUNTY ORDINANCES AND STATE LAWS�, ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. .Af SEWAGE DISPOSAL SYSTEM
I HEREBY CERTfFY THAT I AM PROPERLY •REGISTERED r DISCONNECT PLUG AND
AND/OR LICFKSED' AS REQUIRED BY LOS ANGECES•-COUNTY d ABANDON HOUSE SEWER
AND STATE�W C,A IFORNIA OR THAT [,AM THE;CEGAL OWN-�
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP,PIT(S)[] CESSPOOLS-0
SIGNATURE �-
.� OF PERMITTEE----------P____- -•--�-------..._..................---•----I
76A642D 663 1/531 ;
3