HomeMy Public PortalAbout5541 HALLOWELL AVE_Sewer__ DEPAICrblENT OF COUNTY ENGINEER ' : SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 131
COUNTY,OF LOS ANGELES
WILLIAM J. FOX. COUNTY EADDRESS
NGINEER I BUILDING —: 4 / 9 �
_
FOR APPLICANT TO FILL IN , LOCALITY
BUILDING �-•- /' NEAREST `
ADDRESS J�'7 CROSS ST.
LOCALITY VPAAI-'� DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST . '57' A
CROSS ST.
^ n 'A ECEIVED BY Ready for laepeotioo DATE ISSUED
OWNER // J /
MAIL ^^ c` BK PG USE ZONE OC UPANCY MAP
ADDRESS IE�LL II I �
CITY TEL.NO. A -1.,..--I
CONTRACTORC$liforni8 Sewer Const.Co_ CO.IMP.NO. /L,4 q4
ADDRESS 1317 Colegrove Ave. JOB NO.
CITY Montebello TEL.Nd,TNion 1—F)ms TRUNK PERMIT NO.
STATE
REGISTRATION NO.104448 St COUNTY ROAD PERMIT NO. y
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT WASTE APPROVAL �.
SIZE OF LOTD 1/„� NO.OF
NOW ON LOTS I
I L! CHARGES
USE OF
BUILDINGS Y?f1 14 CONNECTION CHARGE FEE
c. NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENTFEE
PUBLIC SEWER@ $ 3.50
HOUSE SEWER CONNECTING TO RECEIPT ND!-�1I DATE 13.Y----'13.Y----'�
_
PRIVATE DISPOSAL SYSTEM 1.00 It
CONNECT ADDITIONAL BLDG.OR EXCEPTIOWRI�CORDED
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 STATIONDEPTH
1p
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / / / 1 MANHOLEE REFERENCE ly
Tf� / HOLOWER
TYPE OF C NNECTIO� LENGTH FROMO `
OWNERS PERMIT $ I oo r c fP.L M.L.TO P.L. O
AUTHORIZATION TOTAL FEE LiF,SD
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED -
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PLIC SEWER /J
SIGNED THIS....!�0_-__DAY OF-. l,�......19 D NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AG 'I. .. _ BUILDING OR WORK
ADDRE85. r?..x�..`.../_/.1..
......... AND/OR DRAINFIELD SEPTIC TANKSEEP. ITIS)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL(] 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
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
-AND STATE OF'CALIFORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS ;' =
SEEP.PIT(S)0 CESSPOOLS❑a�►'sc� Y-eel 5 �t
SIGNATURE /J) ;
OFPERMITTEE----._.. .--------:-...T._...�_.. ......_..f.--•-•---�._... - i
70A642D 663 1/53
� 1
76A642
CE 8081REV 614) ~
APPLICATION- PERMIT
SEWER - SEWAGE•DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY `
FOR APPLICANT-TO FILL IN DISTRICT NO •GROUP 'MAP • V- 50"SED BY
BK PG
BUILDING G A�
ADDRESS .� �- r •� � '
CONNECTION DAT
LOCALITY ✓I/' • 1
NEAREST STATION DEPTH _•' — 1
CROSS ST .I1 �-� _ _
OPPER'
/// MANHOLE REFERENCE LOWER
OWNER TYPE OF CONNECTION LENGTH FROM-
MAIL Y. CURB P.L. M L TO P L.
ADDRESS PC NO
C� CO IMP.NO. JOB NO ` -
(�
LEGAL -TRUNK PERMIT NO ROAD PERMIT NO
DESCRIPTION LOT NO _ -
AFFIDAVIT WAIVER EASEMENT RECORD.INSTR'NO DATE ,
BLOCK TRACT
•{ NO OF BLDGS
SIZE OF LOT NOW ON LOT HWY OR ST WIDENING
USE OF STATE ENCROACHMENT
BUILDINGS " PERMIT NO ,
' INDUSTRIAL
CONTRACTOR WASTE APPROVAL
ADDRESS CHARGES -
CITY`. TEL NO r CONNECTION CHARGE FEE '
STATE LIC. REIMBURSEMENT FEE ,•
LICENSE NO CLASS '
NO. DESCRIPTION OF WORK FEE APPROVALS DATE INSPECTOR'S SIGNATURE
HOUSE SEWER CONNECTING TO $�
PUBLIC SEWER
SEPTIC TANK,SEEPAGE PIT.OR - NEW HOUSE SEWER �)
PITS AND/OR DRAINFIELD CONNECT ADDITIONAL
HOUSE SEWER CONNECTING TO •/ BUILDING OR WORK
PRIVATE DISPOSAL SYSTEM
CONNECT ADDITIONAL YRB�?SR. AND/OSEPTICR
DRAIN EEL,PIT(S) '
" WORK'TO HOUSE'SEWER AND/OR DRAINFIELD -.
OVERFLOW SEEPAGE PIT,DRAINFIELD CESSPOOL [3DRYWELL❑ ,
EXTN,CESSPOOL:DRYWELL.MANHOLE
ALTER,REPAIR OR ABANDON HOUSE ALTER,REPAIR,SEWER OR
SEWER OR DISPOSAL SYSTEM *SEWAGE DISPOSAL SYSTEM
' DISCONNECT'PLUG AND •"�
ABANDON.HOUSE SEWER `
BACKFILL SEPTIC TANKS❑•. -
' - ,SEEP,PITIS)❑ CESSPOOLS❑
"OWNER �'S Permit ,' , s
AUTHORIZATION TOTAL FEE VALIDATION'
I HAVE AT THIS,DATE,A CONTRACT,WITH THE HEREIN NA ED'CON- 1J77 �(
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING g 4 Z
TO THE PUBLIC SEWER.
SIGNEDTHIS' - DAYOF 19_ - # O O '0,0_1 0
OWNER OR
OWNERS AGENT _ _ (k a
ADDRESS • - . . O d JH O O
IHEREBY,ACKNOWLEDGE THAT'l HAVE READ THIS APPLICATION.' - r O•O'O 1 O F,'
AND,STATE THAT THE•ABOVE IS CORRECT'AND AGREE TO COMPLY' - r WITH ALL COUNTY ORDINANCES-AND'STATE LAWS REGULATING
PLUMBING,AND SEWERS. 0 ill Or !-�7 9, '
,I HEREBY CERTIFY,THAT I AM PROPERLY REGISTERED AND/OR -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALI FO RNIA�O THAT 1 AM THE LEGAL OWNER OF,AND INTENDTO RE-
SIDE IN,THEA OVE DESCRIBED RESIDENTIAL P OPERTY
SIGNATURE '
'OF PERMITTEE �' - )rr