HomeMy Public PortalAbout10661 HALLWOOD DR_Sewer__ DEPAI&MENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUrNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDG
ADDREINSS 6��D
FOR APPLICANT TO FILL IN LOCALITY
BUILDINGNEAREHT
ADDRESS 10661 HnllwOd 7�r. C
OROSS ST. (/111p�.0 es
LOCALITY Temple City DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST.
El Monte Ave. V, A �FrL" S
CROS (-S(b
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P.L. IAC Nutt — /2/P6AY..{ RA_MAIL
ADDRESS 27, j San 'Gabriel Blvd. USE ZONE OCCUPANCY BK MAP PG
CITY San Gabriel TEL.NO. 11T 94364
CONTRACTOR L.D. & M. 00l,STR. CO.
ADDRESS 21 W. e1istiw'ria Ave. JOB NO. r ��
CITY Arcadia TEL.NO. DO 62238 TRUNK PERMIT NO.
-2 STATE
REGISTRATION NO. R�L� (? n.% ❑ COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT NO. SO STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT N0.OF BLDGS.
NOW ON LOT `Z CHARGES
BSOF
UILDINGS Res. & Garar-a CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK -FEE /
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLICSEWER Cpl $ 3.50 _� 0 RECEIPT NO. DAT) BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 f
—ALTER OR REPAIR EXISTING NO 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 3"f p DEPTH /
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00Q/_ �/ 4 W]ANHOLE REFERENCE
4 �/ UPPER L-@NtER'
TYPE OF CONNECTION LENGTH FROM ,{ /
OWNERS PERMIT 1 pp IV— GbRB P.L. "--M.L.TO P.L. b
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....................................19..._... NEW HOUSE SEWER SGVJ)'OG °�'
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT------------------------------------------ BUILDING OR WORK
-_..._..__ SEPTIC TANK.SEEP.PIT(S)
ADDRESS.............
-------_-•-_--------------_------_--•------_- AND/OR DRAINFIELD
CAI HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL[:] DRYWELL
TION 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 - D� 'T } //••��
OF PERMITTEE...�±_s.��.._LPC..LIa_._ __Qx1sLr-.--yQ�..__._---.--_
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