HomeMy Public PortalAbout10606 HALLWOOD DR_Sewer__ DEPAWrMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSALDIVISION OF. ETULDING AND SAFETY PERMIT APPLICATION
CC Ni'll�JF IAS ANGELES
WILLIAM J. FOX. COUNTY ENGINEER ) ADDRESS �Q (O 0 (p
FOR APPLICANT TO FILL IN LOCALITY �J
BUILDING /f �6 /^ p CNEAREST
ROSS ST.
ADDRESS �/ 111 .
LOCALITY DISTRICT NO. p SERIAL N0. PERMIT NO.
A
NEAREST C�� S Si� S
CROSS ST.
/ ,RECEIVED BY Ready for Inspection DATE ISSUED
OWNER L I L
MAIL
ADDRESS USE ZONE OCCUPANCY MAP
n I BK PG
CITY — TEL.NO. /?�� _ .4 IV/A(�e//"1
CONTRACTOR NX0 '�v/J
ADDRESS �o -g.VJOB NO _
q . 5 `J
CITY TELAO. y 3 ¢
STATE TRUNK PERMIT N0.
t p ❑
REGISTRATION NO. ll ®6g �c'��)❑cCQ_tl_MSxys ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT NO. SERMIT NO.ENCROACHMENT
BLOCK TRACTC� INDUSTRIAL /
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS _ Lyts CONNECTION CHARGE FEE
NO. DESCRIPTION" OF WORK FEE \
HOUSE SEWER CONNECTING TO y� REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 C.I RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO /
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDO:OREXCE PTI N RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- >DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00 /
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM - 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR q+ /
PITS AND/OR DRAINFIELD 2.00 STATION /* / d DEPTH G
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 /n / �yIANHOLE REFERENCE
/ L Y[_ UPPER LPR
TYPE OF NNIFCTIONcLENGTH FROM �} C
OWNERS PERMIT $ 1 00 P. �
L. M.L.TO P.L. 2 d
AUTHORIZATION TOTAL FEE 6/ !;
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS--------------------DAY OF........................................19..-_._ [CONNECT
W HOUSE SEWER vh P - �-
OWNER OR 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 E] 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 IAM 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 E]
SIGNATURE SEEP.PIT(S)[:j CESSPOOLS
OF PERMITTEE.- 1. �'*
76A642D 663 1/53