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HomeMy Public PortalAbout10641 HALLWOOD DR_Sewer__ DEPA C MENT OF COUNTY ENGINEER cy' ISR-4EWA E DISPOSAL DIVISION OF BUILDING AND SAFETY " PERMIT APPLICATION. COUNTY_QF LOS ANGELES WILLIAM J. FOX, COUNTY ENGINEER BUILDING ADDRESS l � / FOR APPLICANT TO FILL 1N LOCALITY BUILDING NEAREST ADDRESS 10641 Hallwood Dr. CROSS ST. (� LOCALITY Temple Cit SJ DISTRICT NO. SERIAL NO. PERMIT NO. NEARESTS® 2 CROSS ST. El l�Ont 2 Z�ye a A pRE EIVEDB�Y� Ready for Inspection / DATE ISSUED OWNER P.L. M0 NuttRIAIL / �ltff✓c'J�7 / �L —��c —S� ADDRESS-97212- San Gabriel Blvd. USE ZONE I OCCUPANCY MAP BK PG CITY San Gabrilc1 TEL.NO. AT 94364 A CONTRACTOR L.D. 8c 11e CONSTR. Cis CQ_HNI'_NO. ��- ADDRESS 21 'W.' Wistaria Ave. JOB NO. CITY Arcadia TEL.NODC 6 2.238. TRUNK PERMIT NO. f STATE REGISTRATION NO. 113613 G` `'.- E] COUNTY ROAD PERMIT NO. LEGAL / 76 DESCRIPTION LOT NO. (G STATE ENCROACHMENT • PERMIT NO. BLOCK TRACT 19189 INDUSTRIAL \ J N0.OF BLDGS. WASTE APPROVAL SIZE OF LOT NOW ON LOT CHARGFJS USOF BUE DINGS Res, & Garage CONNECTION CHARGE FEE NO. DESCRIPTION OF WORK FEE \ HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE 1 PUBLICSEWER 0 $ 3.50 3 50 RECEIPT NO. DATE BY HOUSE SEWER CONNECTING TO / PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPT34N RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO. I DATE 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 �� �j © j DEPTH j CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 +3 g MANHOLE REFERENCE UPPER ISR TYPE OF COMNECTION LENGTH FROM OWNERS PERMIT $ I 00 ly� Oki- $` P.L. 4.SM.L.TO P.L. AUTHORIZATION I TOTAL FEE 1 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 HouSESEWER bG �— OWNER OR CONNECT ADDITIONAL OWNERS AGENT----------------------------------------------------------------- „_•-___ BUILDING OR WORK ADDRESS.-....----._-.-..---.---------------------- -- SEPTIC TANK,SEEP.PITS) - - - AND/OR DRAINFIELD 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 1 HEREBY CERTIFY THAT 1 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)� CESSPOOLS(] OF PERMITTEE.-•- - "•" -Ot3�Y`S 3' -- r•------•-•-------•-- 76A642D 6133 1/53 i COUNTY OF LOS ANGELES TEMPLE CITY # 0508 SEWER PERMIT DEPARTMENT OF PUBLIC WORKS 9701 LAS TUNAS SE 0508 0308200008 BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA 91780 PHONE: (626) 285-0488 EXT: -LEGAL ID: SEWER f SEPTIC: X BUILDING AD DRESS: TR: 19189 LT: 76 EXIST OCC GRP: 10641 HALLWOOD DR BLDGS. NOW ON LOT: TEMP CA 917804125 ASSESSOR-INFORMATION NUMBER: CONNECTION TYPE: NEAREST-CROSS STREET: 8585-029-003 ORIGINATION: THOMAS"PAGE:.597 •GR'ID �C4••.;::•,LOCALITY:•'TEMPLE CIT..Y LENGTH ML TO PL: STATION: DEPTH: - TENANT: MANHOLE REFERENCE: UPPER/LOWER: ISSUED ON: PROCESSED BY: EXP IRES-ON: 08/21/03 JK 02/17/04 COUNTY IMPROVEMENT NUMBER: OWNER: TEL. NO: PLAN CHECK NUMBER: FINAL DATE FINAL BY: CODE: LIRA NORA GDN JOB NUMBER: .. . /Jf 10641 HALLWOOD DR TRUNK PERMIT'NUMBER: '• a /1-03 ' TEMP 917804125 ROAD PERMIT NUMBER: DESCRIPTION OF WORK AFFADAVIT: NO NEW 4" SEWER MAIN WAIVER: NO APPLICANT: TEL. NO: EASEMENT: NO MASTERSERV (818) 408-4100- 560 LIBRARY ST RECORD INSTRUMENT NBR: RECORD DATE: SPECIAL CONDITIONS: SAN FERNANDO 91340 HIGHWAY/STREET WIDENING: STATE ENCROACHMENT PERMIT NUMBER: CONTRACTOR: TEL. NO: FEES PAID APPROVALS DATE INSPECTOR SIGNATURE MASTERSERV (818) 408-4100- 560 LIBRARY ST. LIC. NO FEE DESCRIPTION: QUANTITY: UOM: `AMOUNT: NEW HOUSE SEWER _�� 3 � f SAN FERNANDO, CA 91340 580017C20 * 01 PERMIT ISSUANCE FEE 27.75 CONNECT ADDITIONAL 15 ALT/REP HOUSE SEWER 1.00 EAC 30.45 BUILDING OR WORK ARCHITECT OR ENGINEER: TEL. N0: TOTAL FEES 58.20 SEPTIC TANK, SEEPAGE PIT LIC. NO: AND/OR DRAIN FIELD DRYWELL SEWER MAP BOOK: PAGE: ALTER, REPAIR, SEWER OR SEWAGE DISPOSAL SYSTEM DISCONNECT PLUG AND ABANDON HOUSE SEWER BACKFILL SEPTIC TANKS _ SEEP. PIT CESSPOOL GRAYW TER S S EM * ADDITIONAL DATA ON FILE REPORT ID: DPR266 ROUTE TO BS0508