HomeMy Public PortalAbout10618 HALLWOOD DR_Sewer__ &DEPAWJVMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
MU!-k�7f.OF LOS ANGELES /
WILLIAM :y. FOX, COUNTY ENGINEER BUILDING // / 14Z
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ADDRESS
FOR APPLICANT TO FILL IN LOCALITY �¢. �
BUILDINGp� g I, NEAREST
ADDRESS � �n� l/ Xf "��j/ f' 61L �pQ�+ CROSS ST. ( vV
LOCALITY DISTRICT N0. SERIAL N0. PERMIT N0.
NEAREST ' - A L (�
CROSS ST. p •yk� i�l /�J �! —D
/RRECEIVVEED�Bf}Y Ready for Inspection > DATEISSUED
OWNER d l � 1J�� �_-' n.G�s "5'J� Y (J✓(//r'�P ! L ���Sr
MAIL �y �
ADDRESS ��.,. ! txf7 USE ZONE OCCUPANCY BK MAP PG
CITY TEL.NO.,,V7 o f c V
CONTRACTOR
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ADDRESSA Fi�. b Ci)/E%i=°- °�/1� ter• �l'� JOB NO. (r7 S`
CITY !/ TEL.N�O.o� ,d �� TRUNK PERMIT NO.
REGISTRATION NO. 11 b f�� 4"' QwCOUNTY
STATE
ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. STATE ENCROACHMENT
�� PERMIT
BLOCK TRACT INDUSTRIAL /
t
SITE OF LOT N0.OF BL WASTE APPROVAL
NOW ON LOT
� CHARGES
USE OF
DI 1
BUILDLNGS _ r �L-.! �� CONNECTION CHARGE FEE `
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER Q $ 3.50 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO
_ PR?NATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR BE 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
PITS AND/ORDRAINFIELD 2.00 STATIONCI t} DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / MANHOLE REFERENCE T'
tli= f LOWER
TYPE OF CONNECTION ��LENGTH FROe
OWNERS PERMIT $ 1 00 47 a P.L. M.L.TO P.L. 5
AUTHORIZATION TOTAL FEE
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 � b -17`
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT---------------------------------------------------------------------- BUILDING OR WORK
ADDRESS------------------------ SEPTIC TANK.SEEP.PIT(S)
--------------- - -- 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 CO6IPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AND/DR LICENSED AS REQUIRED BY LOS ANGELES COUNTYAND
' DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
-
SSEEP.PIT(S)[:] CESSPOOLS❑
PERM
OF ITTEE- /�t�
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