HomeMy Public PortalAbout5502 HALLOWELL AVE_Sewer__ DEr"IMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ADDREISS ��Q
FOR APPLICANT TO FILL IN LOCALITY (.
BUILDING ' / 1 �/� NEAREST Bl
ADDRESS S`S�Z f1'Q'L,L.OW5-�•L �Y CROSS ST. �✓V'j
LOCALITY A O-GAZ/4 DISTRICT
NO. SERIAL NO. PERMIT/NO. c
NEAREST ^/� d A /�C6-q J
CROSS ST. /Gf
��ff TT ECEIVED BY Ready for Inspection DATE ISSUED
T PLt�. _
OWNER /o9 A R -D H-A7`r9lc kMAIL
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ADDRESS ��� ��® {/t/k7-L'L AVE, USE ZONE OCCUPANCY BK MAP PG
CITY TEL.NO. A-1 l
CONTRACTOR
CO.IMP.N0. 'Y J
ADDRESS
JOB NO.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION NO. B COUNTY ROAD PERMIT NO. .�^•��
LEGAL C7 STATE ENCROACHMENT
DESCRIPTION LOT N0. 1f PERMIT NOS
BLOCK TRACT f 2 3 Q Z INDUSTRIALNO.OF
WASTE APPROVAL,
SIZE OF LOT NOW ON LOTS o. CHARGES `r
USE
BUILDIDI NGS /1��LL�IV& �+ � �y��g CONNECTION CHARGE FE�
.L/ 6� !7
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO @ REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 1� RECEIPT NO.fIO DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR I--,- EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO I DATE �I B�_Y
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR i
PITS AND/OR DRAINFIELD 2.00 STATION 104- 6, 15 DEPTH 19,
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 /_ �"p` MANHOLEREFERENCEV �/
� ®
(Q 0 ' LOWER
TYPE OF CONNECTI( P LENGTH FROM)
OWNERS PERMIT ; I 00 `Y' CtmB L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 4 ,5"a
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS--_._�.r�-�-_---DAY OF_.. �`�'L_"!_L`''_v.__19.2_3 NEW HOUSE SEWER se- r^-e-4,
OWNER OR ,JJ� f�.� CONNECT ADDITIONAL
OWNERS AGENT.......... .. ._. `` - J� BUILDING OR WORK
-.
�,/ t, - q-_L _.. __......}._r..� SEPTIC TANK,SEEP.PIT(S)
ADDRESS-`�j!Z..It-(Y �'-!-�.-..-.---� .. AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL E] DRYWELL E
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE L
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 CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESID NTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE - ? SEEP.PIT(S)o CESSPOOLS ff- roC'
OF PERMITTE --
76A642A 663 7/53 /�,