HomeMy Public PortalAbout5252 HALLOWELL AVE_Sewer__ 78A842D� - APPLICATION'FOR PERMIT
8' eb3 11-55
DIVISION OF BUILDING-AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer .
County of Los Angeles BUILDING 5252 I+Toa Hallowell
JOHN A: LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D GRIFFIN, SUPT of BUILDING ==j LOCALITY Temple City,
FOR APPLICANT TO FILL IN CROSS s.
LEGAL �} - OWNER -
DESCRIPTION LOT NO. l8
MAIL
BLOCK TRACT - 14053 - ADDRESS
NO, OF
SIZE'OF LOT 5 -X 55 NOW ONBLOTS 1 CITY TEL, NO.
USE OF
BUILDINGS DISTRICT -N GROUP MAP
_ B K
CONTRACTOR Jose h Cadilli Plumbing Co. 1 C ✓ `� '"
ADDRESS 7821 E,Garveq Ave S.$.Gabriel, CONNECTION DATA -
STATION DEPTH
CITY TEL. N0. AT 0" UPPER
MANHOLE REFERENCE -
STATE LOWER
REGISTRATION N0. '13 C-36 ❑ COUNTY J• `
NO. DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO, TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L. TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. 0.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. N0,
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1:00 TRUNK PERMIT NO. ROAD ERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 1 00 PERMIT NO. '
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1 00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S' PERMIT S 1 00
AUTHORIZATION TOTAL FEE 2 00 REIMBURSEMENT FEE••
I HAVE AT'THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE /( J
TRACTOR 'TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. • NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK- � % �
OWNERS AGENT - SEPTIC TANK,SEEP,-PIT(S) V �••�
ADDRESS - AND/OR DRAINFIELD
IHEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY '
WITH ALL COUNTY ORDINANCES AND,STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT L[ AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY 'LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR TH I AM THE EG ER O� THE ABOVE
DESCRIBED
CALIFORNIA,
ESIDEN BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) El CESSPOOLS❑
OF PERMITTEE '
JOHN-A. LA BI , COU TY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH
2'2'5"2S;; SEP 1:2, 4 2.00 - 2
76A64�(9.56 APPLICATION- F®Y ■ PERMIT
8a L.
DIVISION OF BUILDING AND SAFETY- SEWER—SEWAGE DISPOSAL
r •' Department of County Engineer q t'
a County of LOS Angeles BUILDING �-J Ir..q� /� 4 014000, Imo /
WM.J. FOX. COUNTY ENGINEER ADDRESS 6�F7 yY Ey fs
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY 7W
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL s p
DESCRIPTION LOT NO. 1AV OWNER, WA 4r,0 A oce
BLOCK TRACT lq®r3 MAIL
ADDRESS
NO. OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF ,�Q / t n
BUILDINGS � jEi L`1 IV
4 DISTRICT NO. GROUP MAP
CONTRACTOR ���,�1�� tt�® A n i g !� � T 7J P O
ADDRESS 3 ANrA AAli rA CONNECTION DATA fJ
CITY A TEL. NO.A r 7 ?e7 7 47 STATION 3,. DEPTH
Cl STATE STATE MANHOLE REFERENCE o � LO
REGISTRATION NO. ! / (� ❑ COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ® Y TYPE URB TIO P.L. MELGTO FR LOM Q
_ PUBLIC SEWER Q $ 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. ORP. C. N0.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. JOB NO.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL /}
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
IHAVE TRACTORTTO CONNECT HIS DATE O THE AABOVE CTED WDESCR DESITH THE CRIBED EXISTING DWELLING APPROVALS DATE INSPECTORS SIGNATURE
TO THE PUBLIC SEWER r'
�s �.9 NEW HOUSE SEWER
SIGNED THIS /�.—DAY OF 19�L �
OWNER OR ' CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
v W- SEPTIC TANK, SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
IO ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL ED DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WISH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER;REPAIR, SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED A5 REQUIRED BY LOS ANGELES COUNTY'AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT-I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC-TANKS C
g � SEEP. PIT(S) ❑ CESSPOOLS
SIGNATURE
OF,PERMITTEE - - -
WILLIAM J. FOX, COUNTY ENGINEER VALIDATION R.A.WOOD. CHIEF PLBG. INSPECTOR
L `1:c10 1 9 2 ,AL2 15 4 4 .5 3