HomeMy Public PortalAbout10607 HALLWOOD DR_Sewer__ YDEPAI i17VIY]+NT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF 13UILDING ARID SAFETY PERMIT APPLICATION
CO'b .' LOS ANGELES
WILLIAM J. /OX, COUNTY ENGINEER f BUILDING
I ADDRESS 1066 ;7
FOR APPLICANT TO FILL IN+ LOCALITY n C
DNEAREST.ADR�S 10607 HaZlwood Dr, C �-�
LOCALITY � + <_Tem-ple Ci DISTRICT N0. SERIAL N0. PERM/IT N0. c
NEAREST A
CROSS ST. El Monte Ave* RE EIVED BY Ready for Inspection DATE ISSUED
OWNER P.L. �F3 Nutt /L_16 — S�
MAIL USE ZONE OCCUPANCY BK MAP PG.
ADDRESS»72 San Gabriel Blydo
CITY San Gabriel TEL.NoAT 94364 A —�
CONTRACTORL.Do & id. CONSTRUCo Coo ce NO. �C Z 3
ADDRESS 21 We Wistaria Ave. JOB NO.
Co 5
CITY ,Arcadia TEL.NO. DO 62238 TRUNK PERMIT NO.
STATE
REGISTRATION NO].13613 C 42 COUNTY ROAD PERMIT N0. \
LEGAL \
DESCRIPTION LOT N0. 71 STATE ENCROACHMENT \\
PERMIT NO.
BLOCK TRACT .9189 INDUSTRIAL 1
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF /'
BUILDINGS Res. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50_ j fi 0 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. I DATE 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 �, d DEPTH /
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 i E- e�ANHO ERREFERENCE
C
TYPE OF CONNIECTION LENGTH FROM 3
OWNERS PERMIT $ IF
00 - tis P.L. ��M.L.TO P.L.
AUTHORIZATION TOTAL FEE 50
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....-_ NEw HOUSE SEWER 5c9 aG - 7.. SQ
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.........................................................................._ BUILDING OR WORK
ADDRESS-----_-------_-_---_------_----_-----. SEPTIC TANK.SEEP.PIT(S)
- AND/OR DRATANK.
SEEP.
ELD
1 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 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. BACKFILLSEPTIC TANKS
�
SIGNATURE SEEP.PIT(S)Ej CESSPOOLS
LeD .. Id ..COstrA -G.o.a......-----------
.: OF PERMITTEE.---•-•-•--........... ...... ..? - -
78A842D 663 1/53 iY7/!l.�_ _ / �