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HomeMy Public PortalAbout10613 HALLWOOD DR_Sewer__ IDEPAIUMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL DIVISION.OF'BUILDING AND 'SAFETY. PERMIT APPLICATION COUNTY OF LOS ANGELES WILLIAM,�J. FOX, COUNTY ENGINEER BUILDING 1�,� ADDRESS FOR APPLICANT TO FILL'IN LOCALITYBUILDINGNEA EST ADDRESS 10613 Ha:llwood Drs CROSS ST. LOCALITY Tf:=le City DISTRICT NO. SERIAL NO. PERMIT NO.�- c NEARESTA CROSS ST. It:1 aDtlOrlt @ A Ve u RECEIVED BY Ready for Inspection of DATE ISSUED OWNERMAIL geZr'e NO Nett ADDRESS 27* San Gabriel Blvd. USE ZONE OCCUPANCY ( BK MAP PG CITY San Gab rie1 TEL.N%T,'94364 A- 1 CONTRACTOR 1a.D.&Mu CONStro Coo � 77;- Ff CSN 0. ,0 '"p.+ ADDRESS 21 y16 Wistaria. Ave. JOB NO. CITY Arcadia TEL.NO.j)0 62238 STTRUNK PERMIT NO. ATE REGISTRATION NO.113613 0 42 Q COUNTY ROAD PERMIT NO. LEGAL STATE ENCROACHMENT DESCRIPTION LOT N0.7.+2 PERMIT NO. BLOCK TRACT 19189 INDUSTRIAL WASTE APPROVAL ) SIZE OF LOT NO.OF BLDGS. NOW ON LOT CHARGES USE BUILDINGS RC•?$e CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE \ HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE 1 PUBLICSEWER Q $ 3.50 _3 RECEIPT NO. D TEi 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 DTE 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 fQ, © DEPTH / CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 / MANHOLE REFERENCE GJ O UEEM11 w LOWER' TYOE OF CONNECTIONLENGTH FROM` Yt OWNERS PERMIT $ I 00 ' t"RB` P.L. v M.L..TOP.L., �J AUTHORIZATION f TOTAL FEE 4 50 1 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 S G D C. 12,-17-54 OWNER OR CONNECT ADDITIONAL OWNERS AGENT--------------------------_---------------•"---- - BUILDING OR WORK -----------•---------- ---•---......._..•-----........ -- SEPTIC TANK,SEEP-PIT(S) ADDRESS..--•--- ----•-----••---------------------- AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] 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 1 AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS SEEP.PIT(S)E].CESSPOOLS❑ SIGNATURE OF PERMITTEE---_Zee--- .-M.o._CQhTME , f 76A642D 663 1/53 �tsz J I