HomeMy Public PortalAbout5508 HALLOWELL AVE_Sewer__ DEPART31ENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
.. COUNTY OF LOS ANGELES
,WILLIAM J. FOX, COUNTY ENDINEER :) BUILDING
ADDRESS �f
FOR APPLICANT TO FILL IN
LOCALITY
BUILDING 1 n NEAREST
ADDRESS 4 �~
CROSS ST.
LOCALITY ^�� �� DISTRICT N0. SERIAL NO. PERMIT NO. C
NEAREST ♦] J �n
CROSS ST. `j /
at1 I f RIIEC�EI�VED BY Ready for Inspection DATE IS UED
OWNERMAIL
ADDRESS �� /�(7 USE ZO/ILE OCCUPANCY BK MAP PO
CITYefa^l� TEL-NO.
CONTRACTOR/J"
/�n/"1�1 s�/�) CO.IMP.NO.
ADDRESS t�► � � JOB.N0.
CITY' TEL.NO. /� J� C6 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 8 COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. PERMIT NO.
BLOCK TRACT �" � INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF NOW ON LOTS CHARGES
USE OF /� �.
BUILDINGS �- a l-r'"� /L>Ci CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT NO. �I -DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO.
ALTER OR REPAIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,!SEEPAGE PIT OR �.
PITSAND/0RDRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 r1U,C p'a,® NHEFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM 7
OWNERS PERMIT 3 I 1 00 �GURBsr K P M.L.TO P.L. � ®
AUTHORIZATION I TOTAL FEE iS C,
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING' APPROVALS INSPECTOWSSIGNATU E DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS----_.----DAY 19-_ NEW HOUSE SEWER /Q- 3
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.................... BUILDING OR WORK
_-------_-,--_--_--___-r.___-,-�-_ SEPTIC TANK,SEEP.PIT(S)
ADDRESS----------_-------------------------- ..-.............. AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL
CATION AND 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 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 1 AM THE LEGAL OWN-
ER OF THE A,00,VE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS C]
SIGNATURE SEEP.PIT(S)E] CESSPOOLSU oGk w–lids3
OF PERMITTE ---__ -- -- - e _Y: _ _ L---
76A642A 663 7/53 /fir