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HomeMy Public PortalAbout4939 HALLOWELL AVE_Sewer__ 76A 6,42 - CE80B - 9/73 APPLICATI N FOR PE MIT . COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDRESS aq 22 LOCALITY - FOR APPLICAN TO FILL IN NEAREST 7 CROSS 5 LEGAL DESCRIPTION LOT NO OWNER MAIL BLOCK` TRACT ( 2, ADDRESS I NO OF BLDGS SIZE OF LOT NOW ON LOT / CITY TEL. NO. USE OF DISTRICT NO. GROUP MAP CESSED BY BUILDINGS BK P3 CONTRACTOR S. ✓� �� - / ADDRESS 3CONNECTIO DATA CITY TEL NO. - STATION DEPTH STATE LIC MANHOLE REFERENCE ,{ UPPER LICENSE N LA 7(-3 (/� .1�4MMt- NO DE CR TION OF-'WORK- FEE TYPE OF CO NECT O LENGTH FROM HOUSE SEWER CONNECTING TO Y ��• M.L.TO P.L. PUBLIC SEWER 0 $7.00 P.C.NO. SEPTIC TANK,SEEPAGE PIT OR J L/ CO IMP PITS AND/OR DRAINFIELD 0 $1000 NO. / JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO`© PRIVATE DISPOSAL SYSTEM Q $3 00 / CONNECT ADDITIONAL BLDG OR AFFIDAVIT I WAIIItt [As[M[MT RECORD.INSTR.NO. I DATE WORK TO HOUSE SEWER ® $300 Or.. OVERFLOW SEEPAGE PIT.DRAINFIELD C) EXTN.CESSPOOL.DRY WELL. Q $500 U ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING - SEWER OR DISPOSAL SYSTEM $300 _STA -T.E-T. ENT' /! ` s � -MANHOL $7.00 PERMIT NO. 4 O /I W INDUSTRIAL - N WASTE APPROVAL Z CHARGES — OWNER'S PERMTf s MAO AUTHORIZATION CONNECTION CHARGE FEE TOTAL FEE - IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE - TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER, APPROVALS DATE INSPECT O SIGNATURE SIGNED THIS�DAAY OF 19_ OWNER OR /// NEW HOUSE SEWER OWNERS AGENT /, CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP.PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS CESSPOOL ❑ ORYWELL I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER. REPAIR.SEWER OR LICENSED S REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFCR OR THAT I AM THE LEGAL OWNER OF. AND INTEND TO DISCONNECT PLUG AND RESIDE N E ABOVE DESCRI RESIDENTI L PROPERTY. ABANDON HOUSE SEWER _ SIGNA RE F ! BACKFILL SEPTIC TANKS Cl / 'SEEP PIT(S) ❑ CESSPOOLS ❑ VALIDATION CK, M.0. 9 7 9�PIAR �1 J.C? 0 76A 642° - CEBDB - 9"3 APPLICATION FO PERMIT , COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL' " DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION J BUILDING ADDRESS LOCALITY 1 FOR APPLICANT TO FILL IN NEAREST CROSS T. LEGAL _ DESCRIPTION LOT NO. Z_ OWNER MAIL .. BLOCK TRACT ADDRESS NO OF SLOGS. j SIZE OF LOT NOW ON LOT 7 CITY TEL. N0. USE OF BUILDINGS- DISTRICT NO. GROUP MAP CESSED BY BK PS 6 .t CONTRACTOR 0 GI T L/Ll ADDRESS CONNECTION DATA GIT EL. NO. 7 STATION DEPTH STAfrE J LICMANHOLE REFERENCE UPPER LICENSE NO. CLAS 7r NO. DESCRIP ION OF WOR FEE TYPE OF NNECTI LENGTH FROM HOUSE SEWER CONNECTING TO Y. M.L TOP L. PUBLIC SEWER 0 $7.00 SEPTIC TANK.SEEPAGE PIT OR P.G.NO. PITS AND/OR DRAINFIELD 0 $1000 CO IMP.NO. "132-14 JOB NO TJ� HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. 'ROAD PERMIT N .O PRIVATE DISPOSAL SYSTEM @ S300 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIY1q 1Al1M1MT RECORD.INSTR.NO DATE WORK TO HOUSE SEWER Q $300 d OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN.CESSPOOL.DRYWELL. a S500 V ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST WIDENING - SEWER OR DISPOSAL SYSTEM Q S300 STATe_ENC ROACHME MANHPERMIT NO. T $7.00 INDUSTRIAL a_ WASTE APPROVAL Z O R�S PERMIT S0 0 CHARGES AUTHORIZATION TOTAL FEE I,HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER " OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS _ SEPTIC TANK.SEEP,PIT(S) IH ACKNOWLEDGE THAT 1 HAVE READ TH 15 APPLICATION 'AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING -• PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL El I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR , LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM ' CA FCRNIA OR THAT I AM THE LEGAL NER OF. AND INTEND TO DISCONNECT PLUG AND R ID THE ABOVE RIB ENTIA ROPERTY ABANDON HOUSE SEWER S NAJ BACKFILL SEPTIC TANKS ❑ ER MffTEE SEEP.PIT 15) ❑ CESSPOOLS ❑ VALIDATION CK. M.0. CASH 9 7 8'-MAR, 3 14 0 3- 0.00 �►