HomeMy Public PortalAbout5236 HALLOWELL AVE_Sewer__ 24650 INSERTS",.
CESOS- -eT!'
76A642APPLICATI.ON FOR PERMIT . _
^ 6A842D COUNTY- OF LOS ANGELES SEWED SEWAGE ®,I-SP_OSAL'- '
'DEPARTMENT OF COUNTY ENGINEER,
BUILDING AND SAFETY,DnnSION eu1LDING -`-' } O,
ADDRESS 'F L�� •`�
JOHN iAMBIE. County En e'er
' WILLIAM'A. JENSEN, Supt of Building LOCALITY-
'NEAREST
FOR-APPLICANT' TO FILL IN CROSS'ST. �" c
j
LEGAL' J bWNER - ?r
DESCRIPTION LOT NO. 7�
BLOCK .TRACT / 61 �A DRESS y y-•�
SIZE OF LO ✓ J ,NOW ON LOT CITY NO.OF'BLDGS. TEL. NO..- ii �.
USE OF
DI ' J DISTRI 0. GROUP MAP- PROCESS BY - .s'4••�.
BUILDINGS Q -
BK Pc� d /
CONTRACTOR (///7�/
f V. /
ADDRESS r)nCO_ CTION DATA
CITY EL.N0. STATION DEPTH 9 �-
r
MANHOLE REFERENCE
REGISTRATION N0. �7 - COUNTY" LO ER.-
ND: DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO -
I PUBLIC SEWER @ $3.00 !J" TYPE0 CTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT,OR -• Y. CUR P.L. _M.L.TO P.L.
PITSAND/OR DRAINFIELD @ $3.00 ,
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN CESSPOOL DRYWELL @ $2.00 _
-HOUSE SEWER CONNECTING TO P.C.NO. -
PRIVATE DISPOSAL SYSTEM @ $1 00 !'CO: IMP. NOr .JOB NO., p.
CONNECT ADDITIONAL BLDG,OR' TRUNK PERMIT N0. ROAD PERMIT NO. V
WORK TO HOUSE SEWER @-$1.00
ALTER, REPAIR OR ABANDON HOUSE - STATE ENCROACHMENT W
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. - - -
'INDUSTRIAL
•, WASTE APPROVAL -- W -
__ _ CHARGES
OWNER'S PERMIT. S. 2 00 CONNECTION CHARGE FEE ;
AUTHORIZATION TOTAL'FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE;A CONTRACT WITH THE HE IN NAMED CON- _ _
TRACTOR-TO CONNECT;THE ABOVE.,DESCRIBED EX STING•DWELLING APPROVALS - DATE, INSPECTOR'S SIGNATURE,
TO THE PUBLIC SEWER. '
SIGNED THIS DAY OF - I9 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 I HAVE READ .THIS-APPLICATION. - - -- -»•
AND STATE THAT THE, 'ABOVE,IS CORRECT AND AGREE TO COMPLY CESSPOOL Cl DRYWELL ❑ ?�•
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR;SEWER OR- r,•.� r '
PLUMBING-AND SEWERS. - �� SEWAGE,DISPOSAL SYSTEM
J%HEREBY-CERTIFY-THAT' 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND;,
LICENSED AS REQUIRED BY.LOS, ANGELESCOUNTY- AND STATE_OF- a
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE - 'ABANDON HOUSE SEWER -
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS'[I�I v� •
SIGNATURE ••'// SEEP.-PITS) ❑ CESSPOOLS -__
OF PERMITTE imm 110m
1/
®e VALIDATION t ROBERT A.WOOD
SUPERVISING MECHANICAL ENGINEEfj
a 3 6-'5 51-0` MM 91 41 D. . 5 POO �. -