HomeMy Public PortalAbout10612 HALLWOOD DR_Sewer__ aDErAw-rmENT OF COUNTY ENGYNEER SEWER—SEWAGE DISPOSAL,
-FFDIVISION.-..OF BTTIT DING AND SAFETY PERMIT APPLICATION
COUNTY, OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING �J NEAREST
ADDRESS ,��� �j� a gypµy.6 eaL CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. '
NEAREST A ��S,2-. �'
CROSS ST -(7S.
. � .''�.t_•t9?.m 1� .l{
RECEIVED BY Ready for Inspection / �yDATE ISSUED
OWNERMAIL
ADDRESS / d - ✓ � trt9 USE ZONE OCCUPANCY BK MAP PG
CITY TEL.NO. �i Cy�lq e�y: — I /&
CONTRACTOR ������ � •, C�$CtP�0 V C._ ;x � �'7'-
ADDRESS �c' JOB NO. S
CITY TEL.NO. 0 TRUNK PERMIT NO.
STATE
REGISTRATION NO. ��3� �3 �'� [�'80tt11I3Y
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. �� STATE ENCROACHMENT
e PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.8F BL
NOW ON LOT
� CHARGES
USE OF
BUILDINGS _ /� �. CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO �/y�' REIMBURSEMENT FEE
PUBLIO SEWER @ $ 3.50 U 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 ��IATE, 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
PITS AND/OR DRAINFIELD 2.00
STATION Q p d DEPTH
CESSPOOL—DRYWELL I
SPECIAL CONDITIONS ONLY 2.00 (�/ MANHOLE REFERENCE
7(O U:e-eE!R t�LOWER
��TYPE OF COWECTIONP L ✓MEL.TOHPFLOM ,
OWNERS PERMIT $ 1 00 .
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMEDi
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING!
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS--------------------DAY OF_-__________....._.-_.______.._._._.....19_.._..., NEW HOUSESEWER $G o r✓ �-/7 :�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT............................................................................ BUILDING OR WORK
ADDRESS......_________________-________-_----_ 'SEPTIC TANK,SEEP.PIT(S)
- AND/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI-, CESSPOOL E] DRYWELL
CAI
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
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.'
OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE -�- ' SEEP.PIT(S)E] CESSPOOLS
- � �rJf � q
OF PERMITTEE---• - - --- ---------7---v' 73'-•---.._._---._.-_�___�_..,_
76A642D '663 1/53 ' /