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COUNTY OF LOS ANGELES FIRE DEPARTMENT FIRE …

FORM 195 Rev. 04/03 Information on fire Flow Availability for Building PermitFor Single Family Dwellings (R-3)INSTRUCTIONS:Complete parts I, II (A) when:Verifying fire flow, fire hydrant location and fire hydrant parts I, II (A), & II (B) when:For buildings equipped with fire sprinkler systems, and/or private on-site fire INFORMATION(To be Completed by Applicant)PART IBuilding Address: City or Area: Nearest Cross Street: Distance of Nearest Cross Street: Property Owner: Telephone: ( ) Address.

PART II (A) INFORMATION ON FIRE FLOW AVAILABILITY (Part II to be completed by Water Purveyor) The distance from the fire hydrant to the property line is

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  Fire, Hydrant, Fire hydrant

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