HomeMy Public PortalAbout10640 HALLWOOD DR_Sewer__ DEPAKTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY--�OF LOS ANGELES
WILLIAM J. FOX, COUNTY EN13INEER BUILDING i�
ADDRESS b C.
FOR APPLICANT TO FILL IN LOCALITY
BUILDING
ADDRESS 10640 Hallwood Dr, NEAREST pa_e M�
CROSS 8T. _e
LOCALITY Temple City DISTRICT NO. SERIAL NO. PERMIT NO. c
CROSS ST. Fl MOIl�e .5-- A 195-1-t _( 3 S
RE EIVEDY Ready for Inspection DATE ISSUED
OWNER P.L. MCNUttMA IL
ADDRESS 272-12- San Gabriel Blvd. USE 20NE OCCUPANCY MAP
BK PG
clTv San Gabriel TEL.No. AT 943fA &
CONTRACTOR L.D. & M. CONSTR. CO. CB-4MP"O
ADDRESS' Bl W. Wistaria Ave.
JOB N0.
CITY Arcadia TEL.NO. DO 69.238 TRUNK PERMIT NO.
STATE
REGISTRATION NO. 115613 C 42 COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. 63 PERMIT NO.
BLOCK TRACT 14A1.89 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BL
NOW ON LOT
CHARGES
USOF
BUE DINGS Res. & GaraGe CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE s
PUBLICSEWER @ $ 3.50 02 50 RECEIPT NO. I DATE BY
HOUSE SEWER CONNECTING TO l
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 A
ALTER OR REPAIR EXISTING NO. I DAT 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 (� DEPTH C�
CESSPOOL—DRYWELL {
SPECIAL CONDITIONS ONLY 2.00 !!LL C M NHOLE REFERENCE
7 UPPER 4
TYPE OF CONNE(;TIONLENGTH FROM
OWNERS PERMIT $ 11 00 &W4141- P.L. M.L.TO P.L. / S
AUTHORIZATION 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 C G _17 y
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT..................................................................... _ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.................................................-..................................... AND/OR DRAINFIELD
I 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
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)E3 CESSPOOLS❑
OF PERM ITTEE.____L.D..___
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