HomeMy Public PortalAbout10660 HALLWOOD DR_Sewer__ DEPAH.TIVIENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
OF LOS ANGELES 4
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS D (o to J FOR APPLICANT /TSO FILL IN LOCALITYBUILDING
NEAREST
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ADDRESS CROSS ST. U-a-'( ` -
LOCALITY 1 DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST C A 'L ' /
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CROSS ST.OWNER t.S[ 5 y� S
c RECEIVED BY Ready for Inspection DATE ISSUED
MAIL !�. ��
ADDRESS J 14F, USE ZONE OCCUPANCY MAP
�y 9 �n^ BK PG
CITY TEL.NO. �j-I/ 2V G,2
CONTRACTOR I y'�/ J f T�=`r��i G4---HVF, l N0.
ADDRESS JOB NO.
CITY � � �,,, TEL.NO.�/ y/f P2 9r TRUNK PERMIT NO.
��� E].a STATE
j
LEGAL
REGISTRATION N0. 1 - `-( f G ❑-COUNTY ROAD PERMIT NO.
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT e �4 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT /-9 CHARGES
USE OF /
BUILDINGS �L, 1 ,-4 CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE c /
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ $ 3.50 RECEIPT NO. I 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 D I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_AND/OR DISPOSAL SYSTEM 1.00 CONNECT -iJ DATA
SEPTIC TANK,SEEPAGE PIT OR /
PITS AND/OR DRAINFIELD 2.00 STATION 3'f' D DEPTH
CESSPOOL—DRY W ELL
SPECIAL CONDITIONS ONLY 2.00 I M NHOLE REFERENCE
O a S W dg UPPER L-6.VmB
TYPE OF CC OONBNEC 'ONP L. M.L.. TO FROM R OM
OWNERS PERMIT $ 1 00
AUTHORIZATION TOTAL FEE
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_.....................................I9-.-_._ NEW HOUSE SEWER 'Sr_ G .2" e
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT--------------------------------------------------------------------- BUILDING OR WORK
ADDRESS...................----------------------.-._-.-- _- SEPTIC TANK,SEEP.PIT(S)
- - - AND/0R 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
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
�GNATURE " SEEP.PIT(S)o CESSPOOLSO
OF PERMITTEE. /Ir� /� --------- ---- - `--------- = '
76A642D 663 1/53
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