HomeMy Public PortalAbout9807 HALLWOOD DR_Sewer__ &E-E•6663 12.54 D
S& All 11 L K A T I O N', O R PERMIT
6
DMSION OF WELDING AM SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles 13UILDING 9807 Hall>reoo7Dro
WM. J. F
OX, COUNTY ENGINEER ADDRESS
CASSATT D. GRIFFIN, SUPT OF BUILDING - LOCALITY
TPm?lP rits_FOR APPLICANT TO FILL IN. NEAREST
CROSS ST.LEGAL _
SCRIP L - .
DECRIPTI��ONjj LOT N0.' / OWNER M. D. Burke
BLOCK /- TRACT / --G�Q'� MAIL
ADDRESS 9807 _HallroOd Dr.,
t N0. OF BLDGS.
SIZE OF LOT NOW ON LOT F CITY Te M le CitZ TEL. NO.
USE OF
BUILDINGS 7�ypA];l l»u DISTRICT NO. I GROUP MAP
EK PG
CONTRACTOR .RTTRKF...HC11T>1,7RT) F -7
ADDRESS 2436 No. Rosemead Blvd. � CONNECTION.DATA
dITY El .Monte, CalifIEL. NO. STATION � -' 3;e3 DEPTH �g 8
STATE �,C( ,.�,$b MANHOLE UPPER REFERENCE
REGISTRATION NO. 132546. [1 COUNTY /✓ �U7Y�/
TYPE OF CONNECTION LENGTH FROM �} 0
NO. DESCRIPTION OF WORK FEE .Y� CURB Bab. M.L.TO P.L.. rnrc.
HOUSE SEWER CONNECTING TO
1 PUBLIC SEWER @ -$-3.50- 3 50
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR
_ WORK TO HOUSE SEWER 1.00 ALTER OR RPAIR EXISTING
CO. IMP. NO. `� ®� JOB. N0. '
_ SEWER R DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. �� ,��
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE '
OWNER'S PERMIT $ 1 00
AUTHORIZATION TOTAL FEE .4 50 REIMBURSEMENT FEE
I HAVE DATE- CON-
TRACTORTHITOS CONNECTO THE ABOVEWITH DESCRBEDTHEH EREIN EXISTINGpMED DWELLING APPROVALS DATE INSP CTOR'S SIGNATURE
TO,THE PUBLIC SEWER - — -NEW HOUSE SEWER /
22 arch
SIGNED THIS 22 O 19�
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ND/O
ADDRESS 9807 Hall wnnd Dr.- T mD e City ITANK,SEEP, PIT(S)
ND/OR�DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑' DRYWELL❑ .
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER.OR
PLUMBING AND SEWERS. SEWAGE-DISPOSAL SYSTEM
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND .STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ fih {t
BUM-EOWARD SEEP.PIT(S).[] CESSPOOLS ]�� j1 rp y
SIGNATURE OF PERMITTEE
WILLIAM J. FOX, CO NTY ENGINEER VALIDATION /,
50
BY BY «
DEPUTY DEPUTY
_. /
BY
BY /
-;® DEPUTY "L' DEPUTY