HomeMy Public PortalAbout5542 HALLOWELL AVE_Sewer__ �YDFPARTMFXT OF COUNTY ENG0TEER SEWER—SEWAGE DISPOSAL
"DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER i, BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY; ti`s
BUILDING X,173/1
p� NEAREST
ADDRESSy ,173/ /II. i�j a//,g e u 29// CROSS ST.' Y1 S
LOCALITY �. D d/dl �GI D�N �) DISTRICT NO. A SERIAL NO. ��jjPERMIT NO. C
NEAREST A 1 Q I —s
CROSS ST. JJ a/77 ES
RECEIVED BY Readylar Inspection 'DA
A� TE ISSUJrED
OWNER W 1 � �0II i-x 1�
MAIL - `, USE ZONE OCCUPANCY I MAP
ADDRESS /V�S •S(� , �[�IIO ur&_6I , BK PO
CITY �YGL)�i a TELNO.
CONTRACTOR cd-0lyll L=.*- CO.IMP.NO.
ADDRESS JOB.NO.
CITY TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION N0, COUNTY ROAD PERMIT N0.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. 3 PERMIT NO.
BLOCKA TRACT /I�b / C/s INDUSTRIAL
WASTE APPROVAL
NO DBLDG
SIZE OF LOT po 'x /6 y 9t, NOW ON LOTS CHARGES
USE OF /� ,G
BUILDINGS /Y�,ev 9L, �.`igna,/aPci. CONNECTION-CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEES
PUBLICSEWER @ $ 3.50 ®' RECEIPT NO. DATE' IBY
HOUSE SEWER CONNECTING TO ! '�•�,
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR _,--EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00NO- DATE DATE 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 , to 5 DEPTH
CESSPOOL—DRYWELL / 8 MANHOLE REFERENCE
SPECIAL CONDITIONS ONLY 2.00
�11P-JrERI LOWEfl
TYPE OF CONNECTION LENGTH FROM
CURT C P M.L.TO P.L.
OWNERS PERMIT $ I I r f�
AUTHORIZATION TOTAL FEE 1 490,
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
NEW HOUSE SEWER
- SIGNED THIS--.._-..._.._DAY OF.. -----19— SG /fG
CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT..................................._..--._.........._._._ SEPTIC TANK,SEEP.PIT(S)
ADDRESS-----------------------.--..--.........._------.-_._...----.._....-._.._..._--.. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I 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 AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-,
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE �/J� ,',(//� y / SEEP.PIT(S)[] CESSPOOLS
OF PERMITTEEL:-l.E '-W-.-V-.--'----rA/-.�!_�a�i ,�
76A642A 663 7/53