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HomeMy Public PortalAbout10645 HALLWOOD DR_Sewer__ DEPAYi.rMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION COUNT]' OF LOS ANGELES ' WILLIAM J. FOX, COUNTY ENGINEER I BUILDING ADDRESS /� / �� � / A ` (p ([,(/J� " FOR APPLICANT TO FILL IN LOCALITY BUDFDING IL ADlOf1064,9HallwQprl T)r NEAREST_ CROSS ST. 'l YY�.fJI LOCALITY Temple City DISTRICT NO. SERIAL NO. PERMIT NO. T NEAREST T A �9S,�'V-� CROSS ST. El Mont E R CEIVED BY Ready for Inspection DATE ISSUED OWNER PoL, Me NuttMAIL ADDRESS 272— San •.a.b iel lyCT USE LONE OC MAP MAP o 4 _ BK PG clrY 'San Gabriel TEL.No. AT 94364 I CONTRACTOR L„TT)„ M. Cnnstre .Oo cQamso-NO.- Re" ADDRESS 21 Wu Wistaria Ave. JOB NO. , S� CITY Arcadia TEL.NO. DO 6 2236 TRUNK PERMIT NO. STATE REGISTRATION NO. 113613,C 42 19 COUNTY ROAD PERMIT NO. \/ LEGAL I STATE ENCROACHMENT DESCRIPTION LOT NO. 'r 7 PERMIT NO. BLOCK. TRACT 19166 INDUSTRIAL } WASTE APPROVAL / SIZE OF LOT NO.OF BL NOW ON LOT 2 CHARGES USOF BUE DINGS Res. & Garage CONNECTION CHARGE FEE NO. - DESCRIPTION ,OF WORK FEE HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE 1 PUBLICSEWER @ $ 3.50 1_f 5 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. I (DATE 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 STATION 2-f ©'.- - DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 // ((�. �I M{►NkOLE REFERENCE p� UPPER �L<01YE� _ TYPE OF CONNEOt10NLENGTH FROM �� OWNERS PERMIT $ .11 �� 13'00 w- G" P.L. M.L.TO P.L. AUTHORIZATION I TOTAL FEE 41 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......._....._..__..................I9 NEW HOUSE SEWER �dijY6-P .2 '/7` 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 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 SEEP.PIT(S)E] CESSPOOLS E] SIGNATURE LoD ....�.��._COLTaSTRn.__at.Q0._.._.._•--_•-•--• 76A6421) 663 1/53