HomeMy Public PortalAbout9818 HALLWOOD DR_Sewer__ PERMIT��pp gge�s 1p��p, /(per g���pq.. g�e� pp��g �gp� ppp9g�p�
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE D S S POSH L.
Deportment of County Engineer
County Of LOS Angeles BUILDING
ADDRESS
WM.J. FOX, COUNTY ENGINEER
CA33ATT D.GRIFFIN, SUPT OF BUILDING LOCALITY t
FOR APPLICANT TO FILL IN NE'SS s.
LEGAL 1
DESCRIPTION r LOT NO. d OWNER
BLOCK 11TRACT N ADDRESS
SIZE OF LOT NOWOONBLOTS �. CITY 3_/ ?. TEL. NO. T 7 6 V
USE OF
BUILDINGS �} (�/,��./�/�/.I.�.J' DISTRICT NO. GROUP MAP
!� I BK PG
CONTRACTOR V !!!!!!
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ADDRESS �— /CONNECTION DATA
CITY TEL. NO'/_' ® _ STATION ® DEPTH q�
❑ STATE MANHOLE REFERENCE % /s ' s �/I�� LO`VE Rif
REGISTRATI ON NO. 9 52 ❑.COUNTY (� �tl�L_
NO. DESCRIPTION OF WORK 'FEE LNTH
HOUSE SEWER CONNECTING TO .Y�PE CURB �CTION MEL GTO P.L.
M
PUBLIC SEWER Q $ 3.50 _
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. ORP,•� P. C. N0.
WORK TO HOUSE SEWER 1.00 CO. IMP. NO. ! J j 0 NO.
ALTER OR REPAIR EXISTING -
EWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT No
S _
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DRAINFIELD .00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
PERMIT CONNECTION CHARGE FEE
OWNER'S S 1 00
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
TRACTORHAVE TTOS CONNECTDATE O THEA ABOVECTED WDESCRIBED EXISTING DWELLING ITH THE HEREIN N.(MED CON- _ APPROVALS DATE !NS ECTOR SSIGNATURE
TO THE PUBLIC SEWER
NEW HOUSE SEWER
SIGNED THISDAY OFA
OWNER ORI CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
�„r ��.� T, SEPTIC TANK,SEEP, PIT(S)
ADDRESS / o n x AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATIOU 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTI L PROPERTY. j1
BACKFILL SEPTIC TANKS❑
—SEEP. PIT(S) F-1CESSPOOLS '/7 ..,C_J,.,Y� G�wl.✓
SIGNATURE
OF PERMITTEE
WILLIAM J.FOX, COUNTY ENGINEER VALIDATION R.A.WOOD, CHIEF FLBG. INSPECTOR
jo
66 6L JUN 4 4.5 7 �'