HomeMy Public PortalAbout5224 HALLOWELL AVE_Sewer__ DEPARTMMNi7,OF Co ENGINEER SEINER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY I PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUIHADD DING
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FOR APPLIC NT TO FILL IN I LOCALITY /♦BUILDING
ADDRESS ICROSS ST.
NEAREST7
LOCALITY DISTRICT N0. SERIAL N0. PERMIT N0.
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OWNER T • G c —9; 1!
MAIL USE 69V OCCUPANCY �i1MIMP�
ADDRESS �_� BK __ PG
CITY- TEL.NO. I ♦w�
CONTRACTOR California SPWRII C,,,rh�fa_�ii�rr-�-Q- ICO.IMP.NO. Z
ADDRESS 1,317 61,8,nvv (1yei JOB N0. S
CITY MOnt@beII3,Ecti'O-California TRUNK PERMIT NO.
REGISTRATION NO. l yS STA
�1 ROAD PERMIT NO. 2— ®'
LEGAL ! STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK ^'' TRACT / �jI INDUSTRIAL Y
++ WASTE APPROVAL
SIZE OF LOT �sX NOW ON LOTS CHARGES z�
USE OF c
BUILDINGS S CONNECTION CHARGE FE
NO. - DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TOREIMBURSEMENT FEE
PUBLIC SEWER 0 $ 3.50 RECEIPT NO. I ATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXC TION RN ORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO• DATI\ BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR go
PITS AND/OR DRAINFIELD 2.00 STATION,2 7,L 7,6 , ,6— DEPTH
CESSPOOL—DRYWELL
HPECIAL CONDITIONS ONLY 2.00 ANHOLE REFERENCE
• UPPER LOWER
TYPE 0 CTION LENGTH FROM
OWNERS PERMIT C RB 411M M:L
AUTHORIZATION TOTAL FEE
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I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING (.• APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO T PUBLIC SEWER J"
SIGNED THIS-.- _. -.---.--DAY OF.... .___.__19- )NEW HOUSE SEWER
OWNER OR
'CONNECT ADDITIONAL
OWNERS AGEN _-._.-. --~• --.. BUILDING OR WORK
ADDRESS..--.- ._ _- - _ /J SEPTIC TANK,SEEP.PIT(S)
-i yt AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL I] DRYWELL I]
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 CALIFOR A THAT I AM THE LEGAL OWN-
ER OF THE ABO E RIB ENTIAL PRQPE BACKFILL SEPTIC TANKS I] Ia�
SIGNATURE
SEEP.PIT(S)[] CESSPOOLS
-
ir
0 -PERMITTEE• -_- - =- ----.... _ •- •----- ..-._._
70A042D 663 1/53F /