HomeMy Public PortalAbout5526 HALLOWELL AVE_Sewer__ DEPXRTMENT OF COUNTY'ENGINEER k -SEWER—SEWAGE DISPOSAL
DI VISION OF BUILDING AND SAFETY PERMIT APPLICATION 9 0 5-
COUNTY OF LOS ANGELES 1
WILLIAM J. FOX, COUNTY ENGINEER �� ADDRESS5'�'�
FOR APPLICANT' TO FILL IN LOCALITY L Q
BUILDING � (�PNEAREST
ADDRESS J Lo �GX CROSS ST.
LOCALITY �nn DISTRICT NO. SERIAL NO. PERMIT NO.
CROSS ST �J D �d Qit�..Q, '4 �g d 9 S
NrRECEIVED BB/Y� Ready for Inspection, DATE/ISSUED-
MAIL ADDRESS %- USE ZONE CUPANCY BK MA PG
CITY TELAO. VIC,
-- -
CONTRACTOR ' [
orn , Sawa —vin,-, ;� CO.IMP.NO. of b .[4•
ADDRESS $ 7 Col.earo;rg Ash. JOB NO. �"�� � L a g V
CITY _ TEL.NO. TRUNK PERMIT N0. - �at vv
REGISTRATION N0. /� CO NTY ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT ND. �`_J,Q. �� ��a SERMIT NO.ENCROACHMENT
BLOCK TRACT/d_St .2, �L",./J ;W,1/ INDUSTRIAL
��
-- E WASTE APPROVAL
SIZE OF LOT'aD X ) r7, — NO 8F SLOGS.NOW ON LOT I, CHARGES T
USE OF ;
BUILDINGS ��� , CONNECTION CHARGE FEE �Y
NO.. DESCRIPTION OF WORK. FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
_
PUBLIC SEWER @)$ 3.50 RECEIPT N0. DATE I^BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLO6.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I 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
PITS AND/OR DRAINFIELD 2.00 STATION �.� �, d !
CESSPOOL—DRYWELL DEPTH
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER L'OWE*
TYPE OF CONNEftION' LENGTH FROM f
OWNERS PERMIT" 3I 00 Ems' ( P,L, M.L.TO P.L.
AUTHORIZATION- TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED- EXISTING APPROVALS, INSPECTOR'S SIGNATURE D4►TE
DWELLING TO THE PUBLIC SEWER , �.
Ty
SIGNED THIS--,30 7,9 AY�F____ _ _d J.__19-2-3 NEW HOUSE SEWER
NECT
OWNER OR o �/! .. .__. .......... ----- BUILDING ING OR WORK
AL
OWNERS AGENT: ___ .._. "____ _
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.__. _._11. ___._.._._ _ .... _.___T__.._.:. AND/OR DRAINFIELD
I•HEREBY ACKNOWLEDGE THAT 1 HAVE READ-THIS APPLI••- CESSPOOL 0 DRYWELL E
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 ABOVE DJIBED 81DENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E) CESSPOOLS
SIGNATURE
OF PERMITTEE_. ---•- ____-._.__--------•--•_--_•---.__._
76A642D 663 1/53
DEPAR'IAMiT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
' DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES BUILDING
WILLIAM J. FOX, COUNTY ENGINEER �I ADDRESS
FOR APPLICANT TO FILL IN LOCALITY "7BUILDING
,
ANEARESTDDRESS E� �1.ja [ �� 14 BAs' CROSS ST,
C
LOCALITY--7-0 DISTRICT.NO. SERIAL NO. PERMIT NO.
NEAREST / J `� 'A o'? p2/ S
CROSS ST. h I V l= C'f:m Ry CEI,VED BY Ready for Inspection �fDATE�ISSUED/�
OWNER
MAIL USE ZONE OCCUPANCY B G
ADDRESS
CITY ��- A TELAO. �-- q` Af
CONTRACTOR-_,_r_t,j+U ilIS1.joLJ I GN' CO.IMP.NO.
ADDRESS i/� �E Vim+ JOB NO.
CITY EF1 M07ar-C- TEL.NO._f�o TRUNK PERMIT NO.
`STATE
REGISTRATION N0. 14;%-7 F7 ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. I PERMIT NO. '
BLOCK TRACT I Q' era. INDUSTRIAL
WASTE APPROVAL
NO.OF
SIZE OF LOT F0�c_ ,l �7O NOW ON LOTS CHARGES
USE OF F
BUILDINGS Qe%s F}� —p*-rL p CONNECTION CHARG hFEE
NO. DESCRIPTION OF WORK FEE
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 ^� RECEIPT NO. I ' TE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCTIO RECORDED
WORK TO HOUSE SEWER' I.00 E'P
ALTER OR REPAIR EXISTING BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR Q
PITS AND/.OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 /_ O Cc MANIHOLREFERENCE �
6 ./ r ER
TYPE OF CONNECTION LENGTH-FROM
OWNERS PERMIT ; 1 00 ARB P.L. M.L.TO P.L. U
AUTHORIZATION 'TOTAL'FEE 6-0
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS IN SIGNATURE DATE
DWELLING TO THccE'��PUBLIC SEWER--{--- f
SIGNED THIS.......Z) AY OF_._.__�!__!_ —�19�'� NEW HOUSE SEWER J-yL'�y.
OWNER OR CONNECT ADDITIONAL
OWNERS AG-
BUILDING OR WORK
•---------- -- - --------..-._..- - - -
7� � SEPTIC TANK,SEEP.PIT(S) ',,p
ADDRESS------ ..�X._e...____ _.. _ _�.Ef.( ___`.....-.-. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[j DRYWELL 0
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
AND STATE OF-CALIFORNIA OR THAT I' AM THE,�I1..EGAL-OWN- ABANDON HOUSE SEWER
SI OF THE-ABOVE DESCRIBEDENT ifOPERTY.-; BACKFILL SEPTIC TANKS
SEEP.PIT(S)� CESSPOOL �
SIGNATURE - -
OF PERMITTEE. ..__...� -•---- -------- - .___.._ - ----•-------•--- -
76A642A 663 7/