HomeMy Public PortalAbout5203 HALLOWELL AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES , BUILDING /
WILLIAM J. FOX, COUNTY ENGINEER �I ADDRESS ,,I',2 6,73 /�.4 LLd GBi/.rL-.L
FOR IA�PPLIC T FILL I LocaurY �r_ c—
NEAREST
ADDRES G w<,0v CROSS ST. 25/4-7 lip 44— Vs `
LOCALITY
DISTRICT 0. SERIAL N0. PERMIT NO.
NEAREST �� ' A �C Lr
CROSS ST. ,
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL USE ZONE OCCUPANCY MAP
_ ADDRESS j/-BK_ L,GPG(/ _
C LAV
CONTRACTOR CO.IMP.NO.
ADDRESS r
JOB N0.
C EL.N —4P6/,00'_ TRUNK PERMIT N0. .
REGISTRATION N0. 3I ® COUNTY ROAD PERMIT NO.
LEGAL / STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT WASTE APPROVAL
DUSTRIAL
SIZE OF LOT ! NO.OF BLDGS.
An NOW ON LOT CHARGES
USE OF
BUILDINGS CONN ON CHARGE FEE
NO. DEEMFAFTION OF WORK ' FEE
HOUSE SEWER CONNECTING TO
e REIMBURSEME E
PUBLIC SEWER @ $ 3.80 RECEIPT N0. ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONN ECMADDITIONAL BLDG.OR1.-�XCEPTION RE ED
WORK TO'HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO. I DATE
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/ORDRAINFIELD 2.00 STATION ��.- �by, DEPTH 9
CESSPOOL—DRYWELL /
SPECIAL CONDITIONS ONLY 2.00G� f /J�}� MANHOLEREFERENCE LUWE
/ v� p
_ TYPE 0 CONNECTION _ LENGTH FROM
OWNERS PERMIT $ Y. CURB P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH TAE HEREIN NAMED `
CONTRACTOR TO CONNECT THE ABOVE SCRIBED EXISTING APPROVALS INS PECTOWSSIGNATU E DAA
DWELLING TO THE PUUBr'C SEWER �'
SIGNED THIS./��_DAY OF-____ _ _. _. —__. I NEW HOUSE SEWER
OWNER ORCMZ (/� CONNECT ADDITIONAL
OWNERS AGENT----------_------_---.-___-_ _ .,_.._____.__ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS________________-.-_____ L
-----•--------------•------------•----------------_.._-------- AND/OR DRAINFIELD ♦.
Ntj
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL ElDRYWELL E]CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE'
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR.
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 ORT AT I AM THE LEGAL OWN-
ER OF THE ABOVE D CRIBE SIDE TIAL PROPERTY. BACKFILL SEPTIC TANKS❑ 1
SIGNATURE OF SEEP.PIT(S)[j CESSPOOLS E
OF PERMIT
TE _ !_ __._. _�___ _.,_r+�t._ ---__-____
76A642A- 663 7/53 k'
4
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT T FILL LOCALITY
BUILDING 6199 NEAREST � v
ADDRESS" of CROSS ST. T
DISTRICT N0. SERIAL NO. PERMIT NO.
LOCALLY J
A � c
`DEAREST _
CROSS ST. ECEI ED BY Ready for InsOeetion Q DATEISSUED
OWN i=x / 1,7
�T
MAILUSE ZONE OCCUPANCY _46A _
ADDRES I v �•,
ClT EL N0. (/ C V
CONTRACT CO.IMP.NO. �j C2
ADD _ JOB.N0.
CI A A TEL.NO� �oiTRUNK PERMIT NO. �1
REGISTRATION NO. - •� �0 fr
COUATE NTY ROAD PERMIT NO. �`y42
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. _ PERMIT NO.
BLOCK TRACT 3 INDUSTRIAL
WASTE APPROVAL
SIZE OFLOT NO.OF BLDGS. / CHARGES
NOW ON LOT
USE OF'
CONNECTION CHARGE FEE
NO. DESC I ION OF WORK, FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 RECEIPT NO. ATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCE 10 RECORDED
WORK TO HOUSE SEWER 1.00 I,
ALTER OR REPAIR EXISTING NO' y D,gTE I BY
_SEWER OR DISPOSAL SYSTEM 1.00 /I
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION)3ATA
SEPTIC TANK,SEEPAGE PIT OR Q
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 zsMANHOLE REFE ENCS
TYPE-OF CONNECTION LENGTH FROM�D d
OWNERS PERMIT _x_ CURB -Pvk - M.L.TO P.L.
AUTHORIZATION I TOTAL FEE g
CONTRACTORHAVE
TO CONNECT DATE THEED TOABOVE DESCRIBED IEXISTING ED APPROVALS INSPECTOR'SSIGNATUR - DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS___--__----__-_DAY OF.-.-. __._.___19NEW HOUSE SEWER
OWNER OR � y �f CONNECT ADDITIONAL
C J �( f BUILDING OR WORK
OWNERS AGENT_..�?_L.......�__�.Yom..!_---.._..�_._..-.J._-_-_-. -
L � SEPTIC TANK,SEEP.PITS)
ADDRESS_.___-6L_..�_N_rT!-n1�_� !3: !nC1__^r !. _.. AND/OR DRAINFIELD
1 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
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AHD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OVCALIF NIA OR AT I AM THE LEGAL OWN-ER OF THE ACRIBED SI NTIAV PROPERTY. BACKFILL SEPTIC TANKSSIGNATURE ool
SEEP.PIT(S)� CESSPOOLSOFPERMITTE --- ------ ------ -2"�d_.:.._.._.._... r
76A642A 663 7/53