HomeMy Public PortalAbout5547-49 HALLOWELL AVE_Sewer__ DEPAPV'IAMNT OF OOUN= ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF .BUILDING AND SAFETY PERMIT APPLICATION
COUN-TY OF LOS ANGELES BUILDING
WILLIAM J..FCX, COUNTY ENGINEER ADDRESS
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FOR APPLICANT TO FILL IN LOCALITY
BUILDINGy� NEAREST
ADDRESS ��S �' %/�� e eoe, ` CROSS ST.
LOCALITY ddNEAREST / ( DISTRICT NO. SERIAL NO. PERMIITT NO. C
CROSS ST. ��(OG. !�/� f` V \ A /�TE U J
RECEIVED BY Ready for Inspection DATE ISSUED'
OWNER 4 ��� f �`
MAIL ,/ USE ZONE OCCUPANCY MAP
ADDRESS 5 Sp��F // . jr9 L4-ou e-e.C_ BK PG
CITY ���I I9 TEL.NOztc O 3 5FL E A -1
CONTRACTOR CO.IMP.NO.
ADDRESS JOB NO.
CITY a/�/j��e��� TEL.NO. J// � TRUNK PERMIT NO.
/ TATE --��
REGISTRATION NO. �O�S^� y� �] COUNTY ROAD PERMIT NO..
LEGAL
DESCRIPTION LOT N0. d f r TATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT �� '� INDUSTRIAL
WASTE APPROVAL
Q NO.OF BLDGS.
SIZE OF LOT /SZ NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
/ HOUSE SEWER CONNECTING TO 'REIMBURSEMENT`F-EE
PUBLICSEWER @ $ 3.50 �� RECEIPT NO. / ATE IBY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPT►ON RECORDED`
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING tdO- .I DATE 1lBY
_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 GRAINFIELD 2.00 STATION S-.�L'66� DEPTH 6
CESSPOOL-DRYW ELL q
SPECIAL CONDITIONS ONLY 2.00 nomNHOLE REFERENCE
I /Q Ln/ �Se / UPPER 4:OJNJrR
TYPE OF CONNE T}� LENGTH FROM
OWNERS PERMIT $ 1 00 _y_. -C"B -(- . ._' M.L.TO F.L.
AUTHORIZATION I TOTAL FEE SL
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBL SEWER gg j
itic
SIGNED THIS.___: ____DAY OF..... ____ ._..._................199- NEW HOUSE SEWER t GrAV-O 11-2¢- ?._3OWNEROR CONNECT ADDITIONAL
OWNERS AGENT--% o �__. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS......
...... ...... ....�._-�__ AND/ORDRAINFIELD
i HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL E] 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 IAM 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 ASIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE / l ® SEEP.PIT(S)[:] CESSPOOLSOF PERMITTEE...rl --- --d l�--------------------
76A642A 663 7/53