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Home My Public Portal About5533 HALLOWELL AVE_Sewer__ 2/70 76.A 642D APPLICATION FOR PERMIT 76,A 6 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION F , JOHN A. LAMBIE, COUNTY ENGINEER / COLEMAN W. JENKINS. SUPT. OF BUILDING FOR APPLICANT TO FILL IN NEARE (PRINT OR T PE ONLY) 7 LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT G7 ADDRESSNOF BLDG - SIZE OF LOT f -1I NOWOON LOTS CITY ' u NO, ,Z- j �1! USE OF �1 DISTRICT NO. GROUP CLASS MAP PROCESSED BY BUILDINGS L,l _ BK p6 C CONTRACTOR � f ADDRESS ✓✓✓ CONNECTION DP1TA t / - STATION DEPTH CITY �t �Y {y��¢.EL. NO. F f r LIC LICENATESE NO,: G+/ V (i CLASS J� MANHOLE REFERENCE NO. .DESCRIPTION OF WORK FEE TYPE OF CONNECTION e LENGTH FROM �g HOUSE SEWER CONNECTING TO Y. CURB p: M.L.TO P.L. v, PUBLIC SEWER @ $5.00 _ / JOBPC.NO. SEPTIC'TANK,SEEPAGE PIT OR CO.IMP. NO. .iJ�/ .10B NO. PITS AND/OR DRAINFIELD @ $10.00 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. A PRIVATE DISPOSAL SYSTEM @ $3.00 O CONNECT ADDITIONAL BLDG.OR n AFFIDAVIT WAIVER 'EASEMENT RECORD. INSTR.NO. DATE U WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL.DRYWELL,MANHOLE @ $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY. OR ST.WIDENING t� / (/r ' i O SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT /(�• "' O PERMIT NO. 7 7CL INDUSTRIAL WASTE APPROVAL OWNERS NES PERMIT S 0 0 CHARGES CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE Oc, I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING �+ TO THE PUBLIC EWER. APPROVALS 4DATEINSPECTOR'S SIGNATURE SIGNED THIS /DAY O .�,/ - 19_ OWNER OR /� ,P. .9 NEW HOUSE SEWER OWNERS AGENT 14 '��G �`t'°�''�P�'�� 'CONNECT ADDITIONAL � ADDRESS BUILDING OR WORK C V 0 SEPTIC TANK,SEEP,PITS) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL I HEREBY CERTIFY THAT 1 AM PROPERLY RGG ISTER,E� AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES CO U�t�TY ND TATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER LTd F,�AND�NTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRI6E RESIDEN TjSA P PE RT Y. ABANDON HOUSE SEWER SIGNATURE // ! BACKFILL SEPTIC TANKS C:l OF PERMITTEE �• �'� SEEP.PITS) ElCESSP OLS ❑ ATIO JACK R. ALLEN CK. O. UPERVISING MECHANICAL ENGINEER M. L CASH Lit :e FEB 7 0 D .0 0 • + r �^ 2/70" 76.A6.A 642D APPLICATI N FORTPRMIT 6 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING y y� JOHN A. LAMBIE. COUNTY ENGINEER ADOREss I7 J COLEMAN W. JENKINS. SUPT. OF BUILDING LOCALITY NEAREST 7GAL OR APPLICANT TO FILL IN CROSS ST. (PRINT OR TYPE ONLY) L , DESCLOT NO. OWNER �5 MAIL BLOCTRACT j (/ ADDRESS -5-07 BLOCK NO. OF BLDGS. SIZE NOW ON LOT CITY TEL. NO. USE OF DIS TRICT NO. GROUP' CLAS 55 MAP P CESSED B BUILDINGS 'MBK CONTRACTOR �v _5Q os e YY i ADDRESS " � CONNECTION DATA CITY , TEL- NO. •-�� STgT10ND� DEPTH e` UPPER STATE LIC MANHOLE REFERENCE �7� LICENSE NO.. CLASS ` 4 �v LO E NO. .DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH Fp M HOUSE SEWER CONNECTING TO Y. CURB M.L.TO P. PUBLIC SEWER @ $5.00 -- SEPTIC TANK.SEEPAGE PIT OR P.G.NO. PITS AND/OR DRAINFIELD @ $10.00 CO,IMP. NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. .. PRIVATE DISPOSAL SYSTEM @ $3.00 Q CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVEII EASEMENTO.RECORD. INSTR.NDATE V WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD p� EXTN..CESSPOOL.DR E @ $5.00 HWY. OR 57.WIDENING O AL REPAIR O BANDON H �v WER R DISPOSAL M @ $3.00 STATE ENCROACHMENT !1 PERMIT NO. d INDUSTRIAL h WASTE APPROVAL z OWNERS PERMIT $ 00 CONNECTION CHARGE FEE CHARGES AUTHORIZATION TOTAL FEE 0-0 IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DAT INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) l I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLGING AND SEWERS. CESSPOOL El ❑ .z' .' I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REOUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR jrHAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE BOVE C IBED RESID TIAL P40PERTY. ABANDON HOUSE SEWER SIGNATURE ^� 441 BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION" JACK R. ALLEN / CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER LliUO 7 7 r Hi; 24 1 0 D 6.C')0IN: 50 INSERTS - .80 7GA642APPLICATION FOR PERMIT 8A842D COUNTY OF LOS ANGELES DEPARTMENT OF COUNTY'ENGINEER SEER-SEWAGE DISPOSAL BUMDING AND SAFETY DIVISION BUILDING ADDRESS Ll. D ADDRESS JOHN A.LAMBIE, County En eer WILLIAM IL JENSEN, Sup't of Building LOCALITYNEAREST FOR APPLICANT TO FILL IN CROSS ST. �� `LEGAL OWNER DESCRIPTION LOT N0. BLOCK TRACT 'MAIL ,ADDRESS , JF NO,OF DGS. SIZE OF LOT' NOW ON LOT CITY 'TEL. N0. O _ USE OF BUILDINGS . `�-+ DISTRICT NO. MAP - PROCESSED BY - CONTRACTOR �0�1 El 0x BK PG ADDRESS - ` CONNECTION DATA CITY y� TEL:N0.�.Q4�,Pjt!!l i , STATION 3^f CT / � f DEPTH STATE P REGISTRATION NO. J O ® COUNTY MANHOLE REFERENCE LOWER NO DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO I ' PUBLIC SEWER @ $3.00 TYPE OF CONNECT LENGTH FROM�� SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L. - 'PITS AND/OR DRAINFIELD @ $3.00 , OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN. CESSPOOL. DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO P.C.N0. PRIVATE DISPOSAL SYSTEM @ $1.00 C0:IMP. NO. JOB NO. M CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO. U WORK TO HOUSE SEWER @ $1.00 ALTER, R DAIRO R A SANDON HOUSE @ $i OO = STATE ENCROACHMENT 03 SEWERPERMIT NO. INDUSTRIAL WASTE APPROVAL Pi CHARGES -d-=-`OWNER'S,'— PERNIIT— $_ « _=2 00 - CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED'EXISTING DWELLING APPROVALS_ DA E'- INSPECTOR•SSIGNATURE TO THE PUBLIC S WER. SIGNED THIS DAY F 19_ NEW HOUSE SEWER I y:L,G�-�i..�4 la A✓: OWNER OR CONNECT ADDITIONAL � OWNERS AGENT' BUILDING OR WORK ADDRESS '3 �• AND/OR DRAINFIELDSEPTIC TANK,SEEP., 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS' APPLICATION, .. _ - AND STATE THAT..THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑ _ WITH ALL COUNTY ORDINANCES AND, STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM ' 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND - LICENSED AS REQUIRED BY LOSANGELESCOUNTY AND STATE OF ABANDON•HOUSESEWER CALIFORNIA 'OR THAT I SAM THE LEGAL OWNER OF' THE ABOVE BACKFILL SEPTIC TANKS Cl DESCRIBED RESIDEN IA PROPERTY. SEEP.PIT( ❑ CESSPOOLS �� ,. r 9 SIGNATURE - i - OF PERMITY 1. IF ' ®r VALIDATI ROBERT A. WOOD - CK. Y.o. CASH ) SUPERVISING MECHANICAL ENGINEER 9. 9 1 6- JUL'.1 2 J C D' 5.0 av