HomeMy Public PortalAbout5507 HALLOWELL AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER—SEWAGE- DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER ) BUILDING
ADDRESS
- FOR//-��APPLICT LANO-FILIN LOCALITY 7,C,BUILDING , l i
ADDRESS �V CROSS ST. �/NEAREST �S of S
LOCALITY
DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A 3S
CROSS ST. BEC -VED- Y Ready for Inspection DATE ISSUE
/
OWNER �'i� / �- �d9 C//A/ S'
MAIL USE ZONE OCCUPANCY MAP
ADDRESS' �- Z /t}CGGf/l7Gl� BK pG
CITY /jam ` TELNO. 26 13 3
CONTRACTOR AA
�1S
CO.IMP.N0. r 7
ADDRESS ',33 A p'( / JOB.NO.
CITY EL.NO. Z TRUNK PERMIT NO.
STATE
REGISTRATION-NO. 8 COUNTY ROAD PERMIT NO.
LEGALDESCRIPTION LO NO/ STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT �i �Z- lm D INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT70 xZb p NOW ON LOTS 4 CHARGES
USE OF Re
BUILDINGS 'C� CONNECTION CHARGE E
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO �yJ
PUBLICSEWER $ 3.50 V RECEIPT N0. DATE IBY
r HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR /E1.60
ECORDED
WORK TO,HOUSE'SEWER I.00
ALTER OR-REPAIR EXISTING NO I DA E IBV
SEWER OR DISPOSAL SYSTEM A.00
DISCONNECT AND ABANDON SEWER
-AND/OR DISPOSAL'SYSTEM. 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR ��!
PITS AND/OR DRAINFIELD � 2.00 STATION fj � DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 rr /y / ANHOLE REFERENCE
l#bRE'R' LOWER
TYPE OF CONNECTIO LENGTH FROM
S � 'OH#b8• �L "' M.L.TO P.L. '
OWNERS PERMIT t 1 00 Gl�jC//(/ 0/v ��/� S
AUTHORIZATION TOTAL FEE /
I 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...%2-__DAY OF_� ; _ 19� NEW HOUSE SEWER se-4 P"6 C - -S�
OWNER OR CONNECT ADDITIONAL
OWNERS AGEN _ ifi. if 13LL+�." BUILDING OR WORK
-� �� ��� �~ ��_ SEPTIC TANK,SEEP.PIT(S)
ADDRESS_.." ..?.�_-_ ,� �%� .._.._..-..._.- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ HIS APPLI• CESSPOOL 0 DRYWELL E]CATIONAND 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 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OFC IFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABO E ESCRIBEDRE DE TIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATU
.� SEEP.PIT(S)
RE CESSPOOLS �.yl �-�/� *'
OF PERMITT .�L! -.... - -• ------- - - ,
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