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HomeMy Public PortalAbout5640 HALLOWELL AVE_Sewer__ DEPAKVrMENT OF COUNTY ENGINEER SEWER—SEWAGE DRSPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM J. FOX. COUNTY ENGINEER BUILDING ADDRESS �5(;4O NaI�OWE? I 1 FOR,tAPPLICANT TO FILL IN LOCALITY-- ,BUILDING C I /�Q NEAREST ADDRESS��( � � � CROSSST. �� �--��� 0AllK LOCALITY DISTRICT N0. SERIAL N0. PERMIT N0. c NEAREST z-- A lPjco-t© -J CROSS ST. RECEIVED BY Ready for Inspection� DAT ISSUED OWNER ' aS?14:t7 MAIL ADDRESS AAA4 10 USE ZONE OCCUPANCY MAP BK PG CITY TEL.NO. ^�^ CONTRACTOCa11f ornla Sewer Const o Co o CO.IMP.NO. ADDRESS 1317 Colegrove Ave. JOB NO. CITYMontebello TEL.PONion 1-5048 TRUNK PERMIT NO. REGISTRATION Na04445TAT StcB QSOUNE ROAD PERMIT NO.LEGAL -�-� DESCRIPTION LOT NO. ' STATE ENCROACHMENT PERMIT NO. BLOCK TRACT INDUSTRIAL �^ SIZE OF LOT80NO.OF BLDG . WASTE APPROVAL NOW.ON LOTS ' CHARGES USE OF BUILDINGS � CONNECTIOa OHARGE FEE N0. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE p HOUSE SEWER CONNECTING TO �– d PUBLIC SEWER C $ 3.50 RECEIPT N0, I �DAfE 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 Sir NO' I DATE I BY SEWER OR DISPOSAL SYSTEM I.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 I-(,-+. Ii , DEPTH 1 CESSPOOL—DRYWELL ` `�� �� SPECIAL CONDITIONS ONLY 2.00 LREFERENCE _ IUrPE TYPE OFCONNECTI LENGTH FROM OWNERS PERMIT $ I 00 P.L. M.L.TO P.L. �� AUTHORIZATION ( TOTAL FEE 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 SIGNED THIS....................DAY OF...........__...._........._...__..19._.__ a NEW HOUSE SEWER �G G OWNER OR /� CONNECT ADDITIONAL OWNERS BUILDING OR WORK AGET/ �!_....��^......,r .. ..__..............__..._._ � SEPTIC TANK,SEEP.PIT(S) ADDRESS �"*-e'!!_�. l.---...-•------_...--_---. 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 I 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 El SIGNATURE //���� SEEP.PIT(S)E] CESSPOOLS OF PERMITTEE��" I:-• !� '.----- _.._. 76A642D 663 1/53. ��