HomeMy Public PortalAbout10634 HALLWOOD DR_Sewer__ DEPAI rMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY,bF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FORS APPLICANT TO LL
-� IN /� LOCALITYBUILDING
ADDRESS [, �j� E�.��faibfY�rJ` bC1�� CROSS STNEAREST.
LOCALITY ` / DISTRICT NO. SERIAL NO. PERMIT NO.NEAREST Its)
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CROSS ST. G�� 5 A ��"�-lOSF S
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OWNER
EC�BY Ready.for Inspection DATE ISSUED
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ADDRESS/ 'v;, �� USE ZONE OCCUPANCY MAP
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CITY �TEL.NO. �� �,
CONTRACTOR
ADDRESS o ��
JOB NO.
�TEL.NO. TRUNK PERMIT NO.
STATE
REGISTRATION N0. h �' /r- 'COUNTY
ROAD PERMIT N0.
LEGAL /
'.-DESCRIPTION LOT NO. (� STATE ENCROACHMENT
f PERMIT NO.
BLOCK TRACT IV INDUSTRIAL
WASTE APPROVAL \
SIZE OF LOT NO.OF BLDGS.
/�/,'� NOW ON LOT CHARGES/
USEOF
BUILDINGS r��/,5,t_"L CA CONNECTION CHARGE FEE
p10. DESCRIPTION OF WORK FEE'
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I A E I BY
HOUSE SEWER CONNECTING TO
P
RIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N
ALTER OR REPAIR EXISTING NO. D'yE BY
SEWER OR DISPOSAL SYSTEM" 1.00 J
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00
CESSPOOL—DRYWELL STATION DEPTH
/�-3�,U
SPECIAL CONDITIONS ONLY 2.00f• , MANHOLE REFERENCE
-/ VV 1'I UPPER Lia
TYPE OF CONNECTION LENGTH FROM /
OWNERS PERMIT $ 1 00 ' Dtm P.L. M.L.TO P.L.
AUTHORIZATION TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOWTO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS...................DAY OF........................................19___-__I NEW HOUSE SEWER G yH C - -S-4L
OWNER -06-- CONNECT ADDITIONAL
OWNERS AGENT------------------------------------------------------------------------------ BUILDING OR WORK
___--------------_. SEPTIC TANK;SEEP.PIT(S)
ADDRESS
---- --------------------------------------------------------- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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
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.P[T(S)E:] CESSPOOLS E]
SIGNATURE
OF PERMITTEE.-L
76A642D 663 1/53