HomeMy Public PortalAbout5217 HALLOWELL AVE_Sewer__ BA642D -
eeoe e•sAPPLICATION FOR PERMIT
- COUNTY OF LOS ANGELES
SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEERBUILDING y ^�
BUILDING AND SAFETY DIVISION ADDRESS
4
JOHN A. LAMSI:E, County En aer
CASSATI D. GRIFFIN, Sup t o! Building LOCALITY
- NEAREST '
FOR APPLICANT TO FELL,
IN CRASS ST.'
LEGAL
DESCRIPTION LOT N0. t! / OWNER
BLOCK TRACT 7
ADDRESS ✓ «r+7>�. "
NO.-OF BLDGS. •.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF sJ ,f
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
trr.. �•VF,
CONTRACTOR �G�- .S'- B� P •( �
ADDRESS $::S F CONNECTION DATA, /
CITY �!C TEL.NO,w—r!e 72, STATION DEPTH
STATE MANHOLE REFERENCE UPPER "
REGISTRATION NO. COUNTY LOWER
NO. DESCRIPTION OF WORK FEE �l }
HOUSE SEWER CONNECTING TO ` L_ w / �7 .
PUBLIC SEWER @ $3.00 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. :h.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD ��_�d
-EXT
N..CESSPOOL.DRYWELL @ $2.00 _
HOUSESEWER CONNECTING TO C.NO.
PRIVA DISPOSAL SYSTEM $1.00 CO.IMP. NO. JOB,NO.
C TCll ADDITIONWA�L 41D OR t 1 00 i TRUNK PERMIT N0. OAD PERMIT NO.
AL ER,REPAIR OR ABANDON Hid S / STATE ENCROACHMENT
EWER OR DISPOSAL SYSTEM L� @ $1:00 PERMIT NO. ^
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERS PERMIT a 1 '2100 CONNECTION CHARGE FEE
AUTHORIZATION rTOTAL FEE 0 REIMBURSEMENT FEE
CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTDATE A CONTRACT-WITH THE IINGAMED DWELLING APPROVAIoS •DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DA OF 19__ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT_. ✓ BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP.PIT(S) -
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR -
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM- PROPER REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELE COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIF IA OR THAT 1 M THE LEG OWNER:OE Tli� OVE
DES IBED ESIDENTI ROPERTY. BACKFILL SEPTIC TANKS ❑
S � SEEP,PIT(S) CESSPOOLS
®► VAIMATIO ROBERT A. WOOD
CL M. SUPERVISING,MECHANICAL IENGINEEH y`
L ;F,4425 ` DEG 16 A 3.00