HomeMy Public PortalAbout10650 HALLWOOD DR_Sewer__ DEPA,JCT ENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVIS-fb" •OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITY
BUILDING //� �P �� �Fit7Ss�� NEAREST
ADDRESS d �J CROSS ST.
LOCALITY .. DISTRICT NO. SERIAL NO. PERMIT NO.
'NEAREST ,a5c
CROSS ST .` '7SZ S� K��
/ /RE EIVED BY Ready for Inspection DATEISSUED.
MAIL
OWNER l/ �' �•
ADDRESS �¢� //cJ �9�f USE ZONE OCCUPANCY BK MAP
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CITY T
_ N0 �l P' �7�� I ✓ I -
CONTRACTOR �-�7-
C�1'�E."N0.- t?
ADDRESS v- J��
JOB NO..
CITY ._,,�, TEL.NO.101 f , TRUNK PERMIT NO.
STATE
REGISTRATION NO. (� , �� A S=GOUN:T-Y
ROAD PERMIT N0.
LEGAL �+ /
DESCRIPTION LOT NO. Cn a PERMIT pNjpROACHMENT
BLOCK TRACT / INDUSTRIAL
SIZE GF LOT N0.8F BLDGS. WASTE APPROVAL
NOW ON LOT CHARG`ES
USE OF �
BUILDINGS � � �L /LhC1 h a� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE '` ` A
HOUSE SEWER CONNECTING TO IREIMBURSEMENT FEE
rl PUBLIC SEWER (alt f 3.50 3 RECEIPT NO. DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1:00
CONNECT ADDITIONAL BLDG.OR EXCEPTIO RECORDED
WORK TO HOUSE SEWER 1.00
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 .� / ��• d DEPTH cp
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / / MANHOLES REFERENCE ` LOWER
TYPE OF CONNECTION `- LENGTH FROM /
OWNERS PERMIT $ 1 00 P•LM.L.TO P.L. /S
AUTHORIZATION I TOTAL FEE 0
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE PUBLIC SEWER APPROVALS INSPECTOR'S SIGNATURE DATE
SIGNED THIS--------------------DAY OF.........................................19.......' NEW HOUSE SEWER17
OWNER. OR CONNECT ADDITIONAL
OWNERS AGENT--------------------------- BUILDING OR WORK
-------------------_- SEPTIC TANK,SEEP.PIT(S)
ADDRESS----
--------------------•-------------------- ••---•-- AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL El
CA
TIONAND 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 AND
DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE �4SEEP.PIT(S)El CESSPOOLS E:]OF PERMITTEE-_C1.......V, �8 �y i7� . "O_'
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