HomeMy Public PortalAbout10600 HALLWOOD DR_Sewer__ DEP A1 fMENT OF COUNTY ENGINEER SEWER®SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS , 60 I
FOR APPLIANT TO FILL IN LOCALITY / ( ,
BUILDING NEAREST p�
ADDRESS 10600 Ha11wOOd Dr o NEARS ST.
LOCALITY Temple City DISTRICT NO. SERIAL NO. PERMIT NO.
CROSS SrA4 S
. El 1Vionte Ave.A4e /Shc ��j�
RE EIVED BY Ready for Inspection DATE/ISSUED
OWNER P.T.o Mo. X4.1-ttMAIL lZ� �IO 'J
ADDRESS 272 5 San Gabrilih Blvd* USE ZONE OCCUPANCY BK MAP PG
CITY San Gabriel TEL.No. AT 94364 _ f 20,1z
CONTRACTOR L.D. & Mo Constr, Coo
ADDRESS 21 Wistaria Ave* )OB NO. (p s s
CITY Arcadia TELAO. Do 62238 TRUNK PERMIT NO. \
[�- STATE
REGISTRATION,NO.I-]_nfil g (: 42 ❑ COUNTY ROAD PERMIT NO.
LEGAL /
DESCRIPTION LOT N0. 69 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT19169 INDUSTRIAL
WASTE APPROVAL 1
SIZE OF LOT N0.OF BL
NOW ON LOT
1 CHARGES
USE
-BUILDINGS Res. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 .1� fin RECEIPT NO. I DATj 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- D BY
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 DRAINFIELD 2.00 STATION f 3 O DEPTH �p /
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00i MANHOLE REFERENCE
Z 0.7 UPPER
TYPE of CONNEQIrION LENGTH FROM
OWNERS PERMIT $ 1 00 "Y= CORB P.L. L-- M.L.TO P.L. 3
AUTHORIZATION I TOTAL FEE 4 50
1HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE 3
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....................DAY OF........................................19.._... NEW HOUSE SEWER
5 r_,
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...........-..............................-........................... BUILDING OR WORK
ADDRESS..............-.......---... ....--.------- .......... SEPTIC TANK,SEEP.PIT(S)
- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL C] DRYWELL
CA
TIONAND 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
IHEREBY 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
- SEEP.PIT(S)� CESSPOOLS�
SIGNATURE
OF PERMITTEE... oDory- 'I3...CQ MaM.----r ..-....y1---
76A642D 663 1/53 j� �� lC�� Q off"G e/ .