HomeMy Public PortalAbout5619 HALLOWELL AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSAL
,yy DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS ANGELES
' WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESSf�7
F. R APP ANT TO FILL IN LOCALITY l��Ciq�O /y
BUILDING NEAREST
ADDRESS 161 VA 6 L L W iz CROSS ST.
���/
LOCALITY DISTRICT N0. SERIAL NO. PERMIT NO.
NEAREST
CROSS ST. Ar
RECEIVED,)BY,, Ready for Inspection J DA
TE ISSUED r�
OWNER
MAIL 1 `
ADDRESS �� "a `L USE ZONEZ' OCCUPANCY l BK MAP PGS
CITY ' TEL-NO. "In
/ IP
CONTRACTOR
,y CO.IMP.N0.
ADDRESSI�'
, JOB.N0.
CITY 1�C/`�//7_{�,e!!//a TELAO.
TRUNK PERMIT NO,
_
REGISTRATION NO. TATE
�'CJ�1� 7 ]-COUNTY ROAD PERMIT NO.
LEL DESCRLOT NO'5hd�k6l �J�® �� � STATE ENCROACHMENT
PERMIT NO.
BLOCK "" TRACT � ��e� INDUST APPROVAL
SIZE OF LOT tfa ?00 N0.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS �� CONNECTION CHARGE FLT
NO. DESCRI13IOPI OF O FEE REIMBURSEMENT FEE
p HOUSE SEWER CONNECTING14.921
B PUBLICSEWER @ $ 3.50 RECEIPT NO. I DATE I BY
j/ HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXC PTION'RECORDED
WORK TO HOUSE SEWER IAO
ALTER OR REPAIR EXISTING NO DAT BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 _ CONNECTION DATA
-SEPTIC TANK,SEEPAGE PIT OR �0 � DEPTH ,e:;'
PITS AND/OR DRAINFIELD 2.00 STATION
CESS
SPECIAL CONDIT ON SLONLY 2.00 I MANHOLE F�EFERENCE
3 V .5 (�UPPEFi� i .SBWE-W
TYPE OF CONNECTION LENGTH FROM
' «�et 8 CSP M:L.TO P.L.
OWNERS I PERMIT $ I I. 0
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREINf NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
.DWELLING TO THE PUBLIC SEWER
SIGNED THIS___--------____-----DAY ._. 19
® NEW HOUSE SEWER p
"r r tet"/a)'
CONNECT ADDITIONAL
OWNER 0OWNERS AGENT _...-__ BUILDING OR WORK
AND/OR DRAINF ELD
CATSEPTIC TANKSEEP. IT,(S) _
ADDRESS-----�--`--`'�-��•�---- -- - ._.-------------------- -- - ........-
CAITHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL E)ION 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 DISCONNECT PLUG AND
AMD/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 RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
6'_> �. SEEP.PIT(S)F] CESSPOOLS Gh m G ® �'
SIGNATURE
OF PERMITTEE-_'-/---- __----- ..-.---------
76A642D 663 1/53