HomeMy Public PortalAbout5516 HALLOWELL AVE_Sewer__ DEPART3DMVT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING 1 1
I ADDRESS 5 � l� •�c�`t C7C1�!SP 1I V�,
FOR AP/PLICANT TO FILL IN LOCALITY
ADDRESSBUILDING�r�4 ffANEAREST ns
LL h wg7L), Avg- ,, CROSS ST.
�
LOCALITY A
DISTRICT NO. SERIAL NO. PERMIT NO.
NCROSS EAR ST. A F3 �7 S C� S/� �/
IRECEIVED BY Ready for Inspection (DATE ISSUED^
OWNER A'.L, Hv Ai p- Ao-a I
R 1"1 a t=c pr_ `,/IMAIL
ADDRESS ,rrI6 fff4LLjq yy�L.L�. ,q//�` USE ZONE' OCCUPANCY I BK ' PG,-
CITY lsr�>7 TELAO. FO-F-71RX/
CONTRACTOR ��,� CO.IMP.N0.
ADDRESS JOB NO.
CITY TEL.NO. TRUNK PERMIT NO. 'c
STATE
REGISTRATION NO. COUNTY ROAD PERMIT NO. -------
LEGAL
LEGAL D STATE ENCROACHMENT
DESCRIPTION LOT NO. r PERMIT NO.
BLOCK TRACT I 9�. INDUSTRIAL
WASTE APPROVAL
NO.OF BLDG& I
SIZE OF LOT SQ ,</7G SIZE NOW ON LOT ��. CHARGES
USE
BUILDINGS- d// WCL,L11Y& CONNECTION-CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO ��99 REIMBURSEMENT FEE /
PUBLIC SEWER @ 3 3.50 3 o RECEIPT NO. /IDAT\ BY
HOUSE SEWER CONNECTING TO !!
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLD6.OR -/EXCEPTION RECORDED \
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO' I DATE BY `^
_SEWER OR DISPOSAL SYSTEM 1.00 s
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR r
PITS AND/OR DRAINFIELD 2.00 STATION f �42 r C) DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 -5a" � /MANHOLE UPPENREFERENCE F_*
TYPE OF CONNECTIO LENGTH FROM
OWNERS REKNIT ; 1 00 �Y�s —sr1RB• P-L. M.L.TO P.L. �r?]
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_.!_? __...DAY OFN�� r!� Iq NEW HOUSE SEWER y L• l� t� .. ,�
OWNER OR � J CONNECT ADDITIONAL
OWNERS AGEN�Ty..._.t._�....._•___._....__ ._...--._.._.-_.__.._.._..._._..._,.�._ BUILDING OR WORK
ADDRESS___ Y'-6. --_:-_.--r`� S�L°�`�. ^VCG�! �+ SEPTIC TANK,SEEP.PIT(S)
1 ---- -•-- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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 1 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 RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS-[ �^ _
SEEP.PIT(S)E] CESSPOOLS c� -G 11—,93
SIGNATURE _
OF PERMITTEE..- — - - - —-— ...... --_
76A642A 663 7/53 J .