HomeMy Public PortalAbout10672 HALLWOOD DR_Sewer__ DEPAI617MENT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISIw OF BUILDING ARID SAFETY' PERMIT APPLICATIONCOUNTY OF LOS ANGELES q
WILLIAM J. FOX, COUNTY ENGINEER BUILDI
ADDRESS
FOR APPLICANT TO FILL IN i LOCALITY "a � (I t
BUILD
ADD EISS /?j�„ '� - OCL "L�(l II NEAREST
CROSS ST.
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. c
CNEAREST ROSS ST. A / /S-�_J q S
�REC�IVED BY Ready for Inspection DATEISSUED
OWNERG.MAIl. Jf�B , �I
AD1)RESS USE ZONE OCCUPANCY MAP
� � ,,,,• , ! � t- I I B K PG
CITY T/)EL.NNOpO��.
CONTRACTOR
ADDRESS JOB NO. �iCS`J
CITY � � TEL.NOZ, 12-7dt TRUNK PERMIT NO.STATE
REGISTRATION N0. h -'C, _ - H COUNTY
ROAD PERMIT N0.
LEGAL .ate�l STATE ENCROACHMENT
DESCRIPTION LOT NO. ...7 / PERMIT N0.
BLOCK TRACT �/ �r/ INDUSTRIAL
SIZE OF LOT N0.OF BL WASTE PPROVAL
_ NOW ON LOT
CHARGES
USE OF �7�.� y
BUILDINGS FAe,'fl, A,.;e,'f 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 l
PRIVATE DISPOSAL SYSTEM IX0
CONNECT ADDITIONAL BLDG.OR EXCEPTIONR CORDED
WORK TO HOUSE SEWER - 1.00
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/ORDRAINFIELD 2.00 STATION L,L f ?7,,S_ DEPTH b
CESSPOOL=DRYWELL
SPECIAL CONDITIONS ONLY 2.00 �- ANUHOLE PPER REFERENCE
TYPE OF CONNVCTION LENGTH FROM
OWNERS PERMIT $ 1 00 Yom- eu4B•- P.L. M.L.TO P.L. J
AUTHORIZATION TOTAL FEE
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 dd..
SIGNED THIS-=---------•--------DAY OF........................................14.,...... NEW HOUSE SEWER eScA v'd�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT...........................................___..__._ BUILDING OR WORK
-------------------------
___
SEPTIC TANK,SEEP.PIT(S)
ADDRESS. - - - - - -.........._. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI. CESSPOOL E] 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
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
SIGNATURE ��) SEEP.PIT(S)� CESSPOOLS❑
OF PERMITTEEAR///!>4' 419
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