HomeMy Public PortalAbout9892 FLAHERTY ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER • SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS n
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FOR APPLICANT TO FIL --IN * LOCALITY
BUILDING NEAREST
ADDRESS 19Z CROSS ST. '
LOCALITY ' w DISTRICT NO. p SE/RI/AIL NO. PERMIT NO. c
NEAREST o r
CROSS,ST. -J (iGtY"
��,,,�, ��//��JJ RECEIVE//D BY Ready for Inspection DATE ISSUED
OWNER ( -7 23 53
MAIL - USE ZONE OCCUPANCY
ADDRESS I � I BK MAP-PG
CITY TEL N0.
CONTRACTOR CO.IMP.NO.
ADDRESS er, JOB.N0. r7 Q 2--
CITY
_CITY � TE/L�.NsO� Q X12 1// TRUNK PERMIT NO.
TATE
REGISTRATION N0.• �3 6 f /L z / "COUNTY
ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT N0. / 7 / STATE ENCROACHMENT
oL� PERMIT NO.
BLOCK TRACT/ �d 0 2 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT V NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF f CONNECTION CHARGE FEE /
BUILDINGS � I
NO. DESCRIPTION OF WORK FEE \
HOUSE SEWER CONNECTING TO 1 REIMBURSEMENT FEES - � ,
PUBLICSEWER @ $ 13.50 'J� RECEIPT NO. I E I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM / 1.00
CONNECT ADDITIONAL BLDG.-OR XCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO' I __-DATE I BY
SEWER'OR DISPOSAL SYSTEM / 1.00 \\
-- - DISCONNECT.AND ABANDON SEWER
— AND/OR DISPOSAL .1 / I.O CONNECTION DATA
SEPTIC TANK,SEEPAGEAGE PIT OR /�
PITS AND/OR DRAINFIELD 2.00 STATION /�i DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
/ I -UPPP-ER— / &0 LOWER
TYPE OF CONNECTIONENCTH FROM 2`7 (
OWNERS PERM T ; I 1 00 Y. CURB. -P.L. M.L.TO P.L.
AUTHORIZATION TOTXL-FEE I u `-D
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
NEW HOUSE SEWER 7
SIGNED THIS-------------PPPPPP-DAY OF......-nw.................................. 19-----"--
CONNECT ADDITIONAL
OWNER ---OR ) - BUILDING OR WORK
OWNERS AGENT ----------- - - -
_, SEPTIC TANK,SEEP.PIT(S)
A _ -
DDRESS-- ..— .
.............- ............... .......................................... AND/OR DRAINFIELD "
I. HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- _CESSPOOL❑ DRYWELL❑
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO-COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULAT!NG PLUMBING AND SEWERS.- SEWAGE DISPOSAL SYSTEM
1 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 RESDENTIAL ROPERTY. BACKFI LL SEPTIC TANKS
SIGNATURE - SEEP.PIT(S)E] CESSPOOLS
OF PERMITTEE ---- ---------- -•• ------- -
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