HomeMy Public PortalAbout10656 HALLWOOD DR_Sewer__ DEPARTMENT OF COSH ENG1NE+EER � SEWER-SEWAGE DISPOSAL,
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COEVTY"ar LOS ANGELES �
WILLIAM J. FOX, COUNTY ENGINEER BUILDING /` / c�
ADDRESS V 1v J
FOR APPLICANT TO FILL IN LOCALITY �� (p
BUILDING NEAREST
ADDRESS 10656 Ha.11w000 T)r; CROSS ST.
LOCALITY Temple City DISTRICT NO. SERIAL NO. PERMIT NO.
CROSS ST. El Monte 5 A ���-�'�_�,o $
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER PoLo Me Nutt / d —/G -S�
MAIL ADDRESS 2722 San Gabriel Bleb c USE ZONE OCCUPANCY BK MAP PG
i �I -
CITY San Gabriel TEL-NO. Al 9430 A- 1 /
CONTRACT, §Do &Mo COnstro Cos` CO.4MF6.NO.
ADDRESS 21 Wo Wistaria Avec JOB NO.
CITY Areadia TEL.NO.DQ 62238 TRUNK PERMIT N0.
EX STATE
REGISTRATION NO. 113613 C 42 ❑ COUNTY .ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. 60 STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT 19169 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BLOBS*
NOW ON LOTT2 CHARGES\
USOF
BUILDINGS Res. & Garaw CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLICSEWER @ $ 3.50 _3 50 RECEIPT NO. I DATE IBY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION CORDED
WORK TO HOUSE SEWER 1.00 _
ALTER OR-REPAIR EXISTING NO. I DATtJ I 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 3 'j 9. v DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 /D MANHOL REFERENCE LOWER
TYPE OF lORNB ECTIONP L �_ LMEL TTOHTROMI
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE '4150
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......._......_..............-......19..._._ NEW HOUSE SEWER <k yn6 Z-
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 I] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO,COMPLY\VITH 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)❑ CESSPOOLS 0
SIGNATURE L D � 1v.. Y
...
OF PERMITTEE..._.... ...-A -. Q .............--• k
76A642D 663 1/53 y+�