HomeMy Public PortalAbout10619 HALLWOOD DR_Sewer__ DEPA VrMENT OF COUNTY F.NGrNEER ! SEWER—SEWAGE ®GSPOSAL
DIVISION OF BUILDIN0 AND SAFETY PERMIT APPLICATION
COUNTY OF I.OS 'ANGELES
WILLIAM J.'T'-OX, COUNTY EN13INEER I ADDRESS a i q � - -�- �✓1rs,
FOR APPLICANT TO FILL IN LOCALITYBUILDING NEAREST
,4„�,,i ,�?�,
ADDRESS 10619 Hallwood Dr. CROSS ST.
LOCALITY Teeple Oi ty DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST
ST. ,T•�.',1 Mont e Ave. 5 A / `f 5%_'g- —73 S
RECEIVED BY Ready for Inspection DATEISSUED
L
OWNER POO McNutt rL /(o --�;�
MAIL
ADDRESS 2�2 San Gabrie 1 Blvd. USE ZONE OCCUPANCY BK MAP PG
CITY Stan GabrielTEL.NO. At 94364 A -- I
CONTRACTOR L.D. & Mo CONSTR.. Co.
ADDRESS 21 Tilo eilistarla Aveb JOB NO.
CITY Arcadia. TEL.NO. DO 62?..--38 TRUNK PERMIT NO.
i STATE
REGISTRATION N0.113613 C 42 O COUNTY ROAD PERMIT N0.LEGAL
\
DESCRIPTION LOT NO. 73 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 19189 INDUSTRIAL J
NO.OF BLDGS. WASTE APPROVAL
SIZE OF LOT NOW ON LOT 2 CHARGES
BSOF
UE DINGS Res. & .Garage CONNECTION CHARGE FEE C,
NO. DESCRIPTION OFWORK FEE \
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE )
1 PUBLICSEWER @ $ 3.50_ RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO r
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING kO- I D4 E I BY
SEWER OR DISPOSAL SYSTEM 1.00 1
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD. 2.00 STATION DEPTH 01
CESSPOOL—DRYWELL
3
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE +' / LOWER,
,
TYPE OF CONBNECTIONp L. `�MEL. TO pFROM p '02-S-
OWNERS PERMIT $ 1 00
AUTHORIZATION I TOTAL FEE 1 4 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 �C Yf9C �Z Y*T” 4
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT-----......................-.........._................................... - BUILDING OR WORK
ADDRESS-------------------------------------------. SEPTIC TANK.SEEP.PIT(S)
--._--------------------•----_._....-----•- AND/OR DRAINFIELD
1 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 I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE _. SEEP.PIT(S)E] CESSPOOLS
�m '
OF PERMITTEE--- -a�a .�
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