HomeMy Public PortalAbout10628 HALLWOOD DR_Sewer__ DEPAIVrMENT,OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION-OF BUILDING AND SAFETY � PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING) ADDRESSFOR APPLICANT TO FILL IN LOCALITY CZ,
BUILDING NEAREST
ADDRESS 10628 H llwood Dr. CROSS ST. POLO (TV_x7
LOCALITY Temple City DISTRICT NO. SERIAL NO. PERMIT NO.
ST. El Monte ave o A �r 5 L� -6!5,s-
-CROSS
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER PoLa MC NjttMAIL
ADDRESS 2722 San Gabriel Bldd o USE ZONE OCCUPANCY BK MAP PG
CITY San Gabriel TEL.No.At 94364
CONTRACTOR LoDo & bl. Constr. Co. c0 +e. P
ADDRESS 21.-'76 Wistaria fives JOB NO. ( S6—
CITY Arcadia TEL.NO. Doo 622�8 TRUNK PERMIT NO. �_
STATE
REGISTRATION N0. 113613 C 42 ❑ COUNTY - ROAD PERMIT N0.
LEGAL
DESCRIPTION Lor N0. 65 STATE ENCROACHMENT
PERMIT N0.
BLOCK TRACT 1918.9 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT 2 CHARGES'
USOF
BUELDINGSReSo & Garage CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE \
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE o
PUBLIC SEWER Q $ 3.50_ RECEIPT N0. 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 ATE 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 DRALNFIELD 2.00 STATION 0¢ �, DEPTH �O
CESSPOOL—DRYWELL
SPECIALCONDITIONS ONLY 2.00 / MANHOLLER REFERENCE
HOLOWER
TYPE OF CONNECTION LENGTH FROMV
OWNERS PERMIT $ 1 00 `�- �1_ P.L. M.L.TO P.L. / 5
AUTHORIZATION I TOTAL FEE 5�
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 SGh
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...........-..............-.............................................. BUILDING OR WORK
. SEPTIC TANK,SEEP..PIT(S)
ADDRESS.............................._. -
---------- ------.....------... ........... AND/OR DRALNFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI• CESSPOOL[:] DRYWELL E]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❑
SEEP.PIT(S)❑ CESSPOOLS❑
SOF PERMITTEE..j!el)a_.8G_SD---C---ontr.o:._C9 a..-.._.---------
._ _ -
76A642D 663 1/53 _ ��