HomeMy Public PortalAbout10651 HALLWOOD DR_Sewer__ IDEPA24,rMENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS
FOR APPLICANT TO-FILL IN LOCALITY
BUILDING NEAREST
ADDRESS 1QEiF'�l FTallWnnc7 T}r, CROSS ST.
LOCALITY T6Dhl0 City
DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A d ��7�ft�
CRoss'ST. F1 Monte Ave. REC�E,I,VgD�,B,Y Ready for inspection d DATE ISSUED
Polio OWNER Poo MC Nutt I L- / 6
MAIL 1 USE ZONE OCCUPANCY MAP
ADDRESS 2721 San Gabriel Blvd- SK PG
CITY San Gabriel TELAO• AT 94364 A
CONTRACTOR -.L0o & Pl.-Constr. Co„ co1 0. p c
ADDRESS 21 W. -Wistaria ripe o JOB N0.
CITY Arcadia TEL.NO. DO 6 2238 TRUNK PERMIT NO.
g] STATE
REGISTRATIONNO. 113E13 C; 42. O COUNTY ROAD PERMIT N0.
LEGAL
DESCRIPTION STATE ENCROACHMENT / {
'rgOT N0, 7j; PERMIT NO.
BLOCK TRACT 1()189 INDUSTRIAL
WASTE APPROVAL \
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES\
USOF
BUE DINGS Res.
& Ga.rae CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK 'FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
1 PUBLICSEWER @ $ 3.50 _ RECEIPT NO. (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 EXISTINGNO• 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 '7g, 0 DEPTH LO
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / MANHOLE RREFERENCE E LOWER
TYPE OF CONNECTION `�LENGTH FROA/ S /
OWNERS PERMIT $ 1 00 00410. P.L. M.L.TO P.L.
AUTHORIZATION I 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.............._........................19NEW HOUSE SEWER G 17
OWNER OR 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
1 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.PIT(S)E] CESSPOOLS
SIGNATURE
OF PERMITTEE.......T•_T1 2 11 (r'eile'Lr""' -------
76A642D 663 1/53