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HomeMy Public PortalAbout9822 HALLWOOD DR_Sewer__ DEPAIV-rMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL DIVISION OF BUILDING AND SAFETY j PERMIT APPLICATION COUNTY OF LOS ANGELES p j WILLIAM J. FOX, COUNTY ENGINEER BUILDING ! ADDRESS n FOR APPLICA T TO FILL IN LOCALITY A BUILDING p' NEAREST ADDRESS �D p�� � ¢ / CROSS ST. v LOCALITY //^' DISTRICT NO. SERIAL N . PERMIT NO.NEAREST c CROSS ST. L70�LrPl1 vGt/r!ff l /i7 C A l O. /�O / J yam) RECEIVED BY Ready for Inspection DATE ISSUED OWNER MAIL ADDRESS�� �/ �r� USE ZONE OCCUPANCY MAP �� I I BK PG CITY T TELAO. /� CONTRACTORk ; CO.IMP.NO. 1 3 Q S— r D ADDRESS,,�,,� JOB N0. C���— TE�Z1 L` 94�� / TRUNK PERMIT N0. ❑ STATE `7 3 RE0. E] 2 _ REGISTRATION NCOUNTY - ROAD PERMIT N0. LEGAL DESCRIPTION LOT N0. (41 STATE ENCROACHMENT PERMIT NO. BLOCK TRACT 3,0 e� INDUSTRIAL WASTE APPROVAL SIZE OF LOT NO.OF BLDGS. NOW ON LOT _ CHARGES USE OF BUILDINGS CONNECTION CTION CHARGE FEE NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE HOUSE SEWER CONNECTING TO �.. PUBLIC SEWER @ $ 3.50 ,� RECEIPT NO. ( /CTr_E I BY HOUSE SEWER CONNECTING TO "�� PRIVATE DISPOSAL SYSTEM 1.00 CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING NO- 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 ���� DEPTH CESSPOOL—DRYWELL SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE 7 /O��C W LOWER TYPE OF CONNECTIO�Y LENGTH FROM �� OWNERS _�ERMIT $ I 00 Y. CURB P.L. ----M.L.TO P.L. AUTHORIZATION I TOTAL FEE 1 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 SIGNED THIS__ .�_..__...DAY OF...... 19 NEW HOUSE SEWER 2 K7 3 OWNER OR CONNECT ADDITIONAL 1 OWNERS AGENT- ._.__.. ._ ................................... BUILDING OR WORK p I ' _ n �] SEPTIC TANK,SEEP.PIT(S) ADDRESS._. .0_Z. ._...15-(� .......__ .c.__�: AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL CATIONAND 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 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 I AM THE LEGAL OWN- ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS El p/ SEEP.PIT(S)� CESSPOOLS©{ 0' r2 � SIGNATURE_ OF PER ITTE_ s x✓{c ......_ 76A642D 663 I/5P