HomeMy Public PortalAbout5643 HALLOWELL AVE_Sewer__ 76AS42D ,O o
CE608.8-SB
APPL9CATMfill, 0R PERMT
COUNTY OF LOS ANGELES SEWIER—SEWAGE MSPOSA
DEPARTMENT.OF COUNTY ENGINEER I
BUILDING AND SAFETY DIVISION u1LDING .i �!„ ..., � L�`L, L�DRESS: iJOHN A. LAMBIE, County Engineer a0.CASSATT D. GRIFFIN, Supt of Building CALITY Co Z)EARESTOSS ST.
i d'l
LEGAL r
DESCRIPTION LOT N0. /+S� rd%v OWNER / Iii LSf�
BLOCK
TRACT/3A I+Ar�'IA� - •� T/1/���I ADDRESS �`� L
NO.OF BLDGS. ,�•
SIZE OF LOT NOW ON LOT CITY f/1 EL.N0.
USE OF `
BUILDINGS. DISTRICT NOj GROUP MAP CESSED.BY
CONTRACTOR'
«� BK PG
,r ADDRESS / �". �.� S j^- CONNECTION DATA
CITY TEL.NO. A,O"6-: j t Q.CA'- STATION DEPTH
° STATE MANHOLEREFERENCE
6 REGISTRATION NO. G ® COUNTY OWER
NO. .. DESCRIPTION OF WORK PEE
J HOUSE SEWER CONNECTING TO a�
p PUBLIC SEWER @ $5.00 TYPE OF CONNECTIO LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR'
Y. CURB P.L. M.L.TO P.L.
PITS.AND/OR DRAINFIELD @ $5.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO q P.C.N0.
PRIVATE DISPOSAL SYSTEM @ $1.00 v' CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG,OR
WORK TO HOUSE SEWER .00 ,� TRUNK PERMIT NO, ROAD PERMIT N0.
@ $1 '
SEWER'OALTER R DISPOSAL SYSTEABANDOM HOUSE @ $1.00 STATE ENCROACHMENT
z', PERMIT NO.
INDUSTRIAL
- - " WASTE'APPROVAL'
s CHARGES .
QER'�' PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE ?.' REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. a APPROVALS DATE 1N PECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING 'DWELLING 'i
TO THE PUBLIC.SEWER.
:. SIGNED THIS / AY OF 19 NEW HOUSE SEWER
OWNER OR ! CONNECT ADDITIONAL
OWNERS•AGENT - BUILDING OR WORK - -
Vol. SEPTIC TANK,SEEP,PIT(S) '
ADDRESS _ AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION a AND STATE.THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY " CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE .LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY 'REGISTERED AND/OR DISCONNECT PLUG AND -
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF .ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIA PROPERTY. BACKFILL SEPTIC-TANKS❑ t
SIGNATURE SEEP.PITS) [ICESSPOO
OF PERMIT**E y
lTALIDATI ROBERT A.WOOD'
„' M.or cA�g SUPERVISING MECHANICAL ENGINEER