HomeMy Public PortalAbout10667 HALLWOOD DR_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUMW, "NF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING
I ADDRESS
Rose
FOR APPLICANT TO FILL IN LOCALITY
BUILDNG NEAREST
ADDREISS 10667 Fullwood Dr. GROSS ST.. (Pal (l "eJ
LOCALITYj�mx�la City DISTRICT NO. SERIAL NO. PERMIT NO.
�l
NEAREST S- A
c
9 SG.�Le+��J
CROSS ST., Tel MontA Ave, ECCEEIIVEDDA BY Ready for Inspection DATE ISSUED
OWNER P.L. YIC Nutt
ADDRESS 272MAIL1 San Gabriel Blvd, U(SE ZONE OCCUPANCY MAP
CITY San Gabriel TEL.NOAT 94564 /I � / � BK PG
T(L
CONTRACTOR L.D. toe Al. CGHSTR. Co. _(/ '� `,
ADDRESS 21 W. Wistaria Ave. JOB NO.
CITYAr(__,di, TELAO. 1;29313 TRUNK PERMIT NO.
STATE
REGISTRATtONINI7. 113615 C 42 - ❑ COUNTY ROAD PERMIT N0. \/
LEGAL PERMIT NCROACHMENT
DESCRIPTION LOT NO. STATE EN
BLOCK TRACT 19189 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOBS.
NOW ON LOT 2 CHARGES
USE
BUILDINGS iJ, 6S� � �Pc`�,�E�
CONNECTION CHARGE FEE
�
NO. DESCIRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLIC SEWER @ $ 3.50 3 50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTIA RECORDED
WORK TO HOUSE SEWER 1.00 '
ALTER OR REPAIR EXISTING k0. 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 ! t�[�� DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / ry1/1NUPPERHOLE REFERENCE
to i}� t�EA,
06 TYPE OF CO aBNEC�fFONP L. Ce./ MEL.TOLNGTRP BOM L.
® a
OWNERS PERMIT $ I 00
AUTHORIZATION TOTAL FEE 4 50
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....................DAY OF...................._..................19.._._ NEW HOUSE SEWER Sc
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.------------------------------------------------------------------------------ BUILDING OR WORK
.............. SEPTIC TANK,SEEP.PIT(S)
ADDRESS...
-•--•---------------------- ----•-•------------------------------------- AND/OR DRAINFIELD
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,REPAfR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
f HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP-PIT(S)ED CESSPOOLS 0
SIGNATURE L.D. -- Fvlo
--
OF PERMITTEE..._..---••---- - -'-O/Y1S.�t�.a.._�i-.at......-•-•-----
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