HomeMy Public PortalAbout5246 HALLOWELL AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES.
WILLIAMFOX. COUNTY ENGINEER ADDRESS 522 (o IV yam/110 u-)ell Aye,
CASSATT D.. GRIFFIN,-Sua�T ❑F BUILDING
FOR APPLICANT TP FILL IN LOCALITY
ABUILDINGDDRESS �,L A/ ,¢�Lpl,�f,y LL �b EAREST /
Sa' i � N} / CROSS ST. �IeQl /- ��1D a�n S�
LOCALITY �jT�I32 p,c �_ �� DISTRICT NO. SERIAL NO. PERMIT NO.
CNEARESTROSS ST. 'f' ) Lo ,4NN• 5 A Z/23� L1/ 68 S
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER_ , R�C11 A. N�o/g .lie
MAIL S Z!2 ►m C
ADDRESS USE ZONE OCCUPANCY MAP
BK PG
CITY �yTEL.NO.FZ> t� & 3�
CONTRACTOR C/"�,6SS/L/1" -1(,yaki-1=-1q/3e1?6 C^, CHARGES REIMBURSEMENT FEE
ADDRESS Q� �. �p V�+�t d-� ���r REQUIRED
NOT REQUIRED
CITY 01 �L.NO./q �.�Z.m JOB.N0. CONNECTION CHARGE FEE
STE
/
REGISTRATION NO. 7 E i" CO.IMP. N0.
LEGAL RECEIPT NO. I DATE I BY
DESCRIPTION LOT NO. ��/
BLOCK TRACT /-7 'T O S3 WAIVER FOR RECORDING
SIZE OF LOT SS X /Loo_ NOW ON LLOTGS �. RECEIPT NO. I DATE I BY
USE OF
BUILDINGS
.NO. DESCRIPTION OF WORK FEE TRUNK PERMIT N0.
,PUBLIC C SEWER HOUSE SEWER CONNECTING TO ; 3.50 j�� ROAD PERMIT N0.
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSALSYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 /
SEPTIC TANK,SEEPAGE PIT OR
STATION /1f/17, -� DEPTH Ip
PITS AND/OR DRAINFIELD 2.00 MANHOLE EFEF NCE ^
CESSPOOL—DRYWELL UPPER L-OWER=
SPECIAL CONDITIONS ONLY 2.00 I I TYPE OF CONNECTION LENGTH FROM 1 /
Y. --- CURB ✓ P.L. M.L.TO P.L. CJ
OWNERS PERMIT # I 00
AUTHORIZATION TOTAL FEE .SO ,
1 HAVE THIS DATE CONTRACTED WITH THE .HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWE� r �, /l
SIGNED THIS..-.._1-.-------_DAY OFA-- _....-.___ --_.----19..�.�' NEW HOUSE SEWER
OWNER OR /��� CONNECT ADDITIONAL I i
OWNERS AGE N .---Ckt. .---.`.�.�...... :.. _ _ BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
ADDRESS-4-A... p-Alo. �Ci,,�• AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1-H'AVE READ THIS APPLI- CESSPOOL DRYWELL
CATIUN AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO C051PLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR SEWER
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 OR THAT I AM THE LEGAL OWN-
ER OF THE AB VE DESCRIBEW
DENTIAS PROPER BACKFILL SEPTIC TANKSSIGNATURECHr'SS� NOL<6N <Rl C SEEP.PIT(S)� CESSPOOLS❑OrOF PERMITTEE-.. ..-... - R
76A642D 663 12/52