HomeMy Public PortalAbout10673 HALLWOOD DR_Sewer__ DEPAWfft ENT OF COUNTY ENGINEER SEWED®SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION .
COUNTY-OF LOS ANGELES
WILLIAM J. FOX, COUNTY EN13INEER I ADDBUILREDING
I SS (d
FOR APPLICANT- TO FILL IN LOCALITYBUILDING NEAREST
ADDRESS 10673 Hallivood Dr. CROSS ST. �
LOCALITYDISTRICT NO. SERIAL NO. PERMIT NO.
rl l=l 1 r ("J tai p
CROSS ST. El Monte Ave. Sr A
RECEIVED BY Ready for Inspection ; DATE_ISSUED
OWNER P. T_ NI('. Tbi ,t SIL . —/�o " 53
MAIL
ADDRESS 272-n BK San Gabriel Blvd. USEZONE OCCUPANCY MAP PG
CITY San Gabriel TELAO. AT 94364 /.} / I /
CONTRACTOR L.D. 8C M. Constr. Co. .CO,-I� m"O. TC,
ADDRESS 21 We Flistaria. pve. JOB NO. �S 5
CITY Arcadia TEL—NO—Do 62238 TRUNK PERMIT NO.
11
Q STATE
REGISTRATION NO. 11-SA13 L'' 42 ❑ COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT NO. 82 PERMIT N0.
BLOCK TRACT 1919 INDUSTRIAL APPROVAL
SIZE OF LOT NO.OF BL
NOW ON LOT CHARGES /
USE OF
BUILDINGS RAR Q (=n,1+}}pA CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE \
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER Q $ 3.50 s RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER I:00 I
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 CONNECT106 DATA
SEPTIC TANK,SEEPAGE PIT OR / �
PITS AND/OR 7/DRAINFIELD 2.00 STATION ��-/7a'S DEPTH C
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / / G 119ANHOLE REFERENCE
J I UPPER L=-1#i
TYPE OF CONNEVION LENGTH FROM
OWNERS PERMIT $ 1 00 P.L. M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 1 41 50
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....................DAY OF.......-............-.................19..._.. NEW HOUSE SEWER �� vD c 3
OWNER OR CONNECT ADDITIONAL
OWN ERS AGENT.---------•-•---------------------------------------- ------- BUILDING OR WORK
ADDRESS.......................------_-_--------------------.................................. SEPTIC TANK,SEEP.PIT(S)
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.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 E
SEEP.PIT(S)[] CESSPOOLS E
SIGNATURE
OF-PERMITTEEL -------------
76A642D 663 1/53