HomeMy Public PortalAbout5511 HALLOWELL AVE_Sewer__ DEPARTMENT OF COUNTY ENc3IINIMM SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND` SAFETY PERMIT APPLICATION
COUNTS OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN117
LOCALITY
BUILDING y�p AA �t ° NEAREST
ADDRESS c% /I L/ �y'7� Tct! � . CROSS ST.
LOCALITY P•�� DISTRICT NO. Ready for Inspection7; 71
RMIT NO.
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CROSSSL l�NEAREST ° '
rfr LJ"{ (ItJIIZ- .'�) �/� N L�� �l D
RECEIVED BY 1 JATE ISSUED BY DATE
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OWNER � � � //,' Com' , .( J I
MAILADDRESS pry SE ZONE OCCUPANCY B—MAP--
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CITY / O '/� 1/e l.��TEL.NO. ��lj lG�' f;. ,Y `3�� i Gam/ -7
CONTRACTOR C+o tli„s S�_ CO.IMP.NO.
ADDRESS 5933 N. CLOVERLYAVE_ JOB.NO.
CITY TEAAP�&,VIV, CALIF. TRUNK PERMIT NO. ^^
REGISTRATION NO. G'-YZ 70/ CPU NTY ROAD PERMIT NO.
LEGAL ~ STATE ENCROACHMENT
DESCRIPTION LOT N0. / � PERMIT NO.
BLOCK TRACT 7^ /i'ar'��� 'a w INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT �7 INOW ON LOTUSE OF
S , CHARGES
BUILDINGS �' ,` /
CONNECTION CHARGE FEE
NO. DESCRIPTION—OF WORK FEE
HOUSE SEWER CONNECTING TO 7� REIMBURSEMENT FEE
PUBLICSEWER CD $ 8.50 SSL' 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 N0. / DATE I BY
ALTER OR.REPAIR EXISTING
_ SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION / �� DEPTH ��►
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 /1 0l C�MANHOLE REFERENCE __
n! J UPPER y
Y =E OF CONNECrTIONPc� MEL .TO PNGTH
ry Q
OWNERS PERMIT ; t 00
AUTHORIZATION TOTAL FEE -
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 (9_ NEW HOUSE SEWER
CONNECT ADDITIONAL
OWNER OR OWNERS AGENT_ 1Lc??_�_ r4 `-��* BUILDING OR WORK
Yr M_. __._._�.�r.- �.._
SEPTIC TANK,SEEP.PIT(S)
ADDRESS..........................--------___ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] 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 I AM THE LEGAL OWN-
ER OF THE A13OVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS 0
SIGNATURE 1�w e C." SEEP.PIT(S)E] CESSPOOLS E]
OF PERMITTEE..
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