HomeMy Public PortalAbout5632 HALLOWELL AVE_Sewer__ DEPAKr11IENT OF COUNTY ENGINEER SEINER—SEWAGE DISPOSAL 8'0 5 I
T DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES T/
WILLIAM J. FOX. COUNTY ENGINEER I ADDRESS- J CO �,/�o�
FOR APPLI=NT FILL INS//{ t//J� LOCALITYBUILDING`ya�/ 4j Y f NEARESTADDRESS ��ll (( (� �j a /� ( CROSS ST. (J
LOCALITYNEAREST ����l �����,-' - DISTRICT N0. SERIAL N0. P,ERMIT N0. c
CROSS T.
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n RECIPVEDj,BY
� Ready for Inspection DATEaI�SSUED_
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CONTRACTOR.ddi1f GIT'Y11EI Seger dozisi'_(in C/0�.IMP.7NO. / 4
ADDRESS 1&i'r dgllekfgVig' AV®'' JOB NO.
CITY �r�� qq�,^ TELAO - r r,p TRUNK PERMIT N0.
REGISTRATION NO.�L 'tt4 ❑ QTE
tlJNTY ROAD PERMIT NO.
LEGAL J�]���`�D
DESCRIPTION LOT N0. � STATE ENCROACHMENT _---
o� PERMIT NO.
BLOCK' `TRACT ' � INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT/,/43
4 X/ ® N0.OF BLDGS.
NOW ON LOT 1 CHARGES
BSEOF
UI DINGS CONNECTION CHARGE�F�EE
N0. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE/, �
HOUSE SEWER CONNECTING TO o 22
PUBLIC SEWER @ $ 3.50 N RECEIPT NO.�/ I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED'
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO DATE I B
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK.SEEPAGE PIT OR �f
PITS AND/OR DRAINFIELD 2.00 STATION �' J v DEPTH �r
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 �c 3 MANHO LE ER REFERENCE A% LOWER
TYPE OF CONP CONNECT LEN TL. O F OM ® /
j OWNERS I PERMIT $ 1 00
AUTHORIZATION TOTAL FEE y1496
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER � � Qn
SIGNED THIS-- .0���AY OF-_- iC:( _..19 J NEW HOUSE SEWERS
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT...
� _--- 1 .... BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
ADDRESS-5-41-32-1_ =- ..------- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL❑ DRYWELL 11
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 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 RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S)� CESSPOOLS
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OF PERMITTEE. _........
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