HomeMy Public PortalAbout10657 HALLWOOD DR_Sewer__ DEPA TMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
;0O,W04i7 OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITYBUILD
EI
NG NEAREST
ADDSS 10657 FLa. � V
l�woe� �'-
CROSS ST.
LOCALITY Temz)le City DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST A -77/ S
CROSS ST. E1 Monte Ave. /95 ��
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER Pa L .gifin 711tt
AAIL
DDRESS 272-;:,�- San Gabriel Blvd. USE ZONE OCCUPANCY BK MAP PG
CITY San Gabriel TEL.NO. LT 94364 A ®(
CONTRACTOR L.D. & kilo C(]lqSTRe Co•
ADDRESS 21 101. Wistaria Ave* JOB NO. �m
CITY TELAO. 110 69 2,38 PERMIT NO.
STATE
REGISTRATION N0. 113613 G' 42 ❑ COUNTY ROAD PERMIT N0.
LEGAL 7 STATE NOROACHMENT ]
DESCRIPTION LOT N0. 9 J
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF SLOGS.
NOW ON LOT 2 CHARGES
USE OF
BUI DINGSR6S a & Garage CONNECTION CHARGE FEE ,�
NO. . DESCRIPTION OF WORK FEE /
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 RECEIPT NO. DATE i BY
HOUSE SEWER CONNECTING TO t
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 "
ALTER OR REPAIR EXISTING N0. I DATE 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 f-��i d DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 //,/ / MANHOLE REFERENCE LOWER
TYPE OF CONNECTION LENGTH FROM
'y^ - P.L. �� M.L.TO P.L.
OWNERS PERMIT $ 1 pp S/
AUTHORIZATION I TOTAL FEE 4 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............_._--_......_..........19..._... NEW HOUSE SEWER '5cA 7
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT-----------------------------------------------------------_---------------_ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS............................................................................................ AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] 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
I 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
SIGNATURE IrsD• a �t��__+'D Sti�'a---Qa........._.......
OF PERMITTEE..._.......�..--.-.-
78A842D 663 1/53 ��w `f ,�