HomeMy Public PortalAbout9828 HALLWOOD DR_Sewer__ �. D
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DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
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Department of County Engineer
County of Los Angeles BUILDING �Ro (i /J/J /]WM. J. FOX, COUNTY ENGINEER ADDRESS ( iiCASSATT D. GRIFFIN, Super of BUILDING LOCALITYZell"*.A .J 01Xdi
FOR APPLICANT TO FILL IN NEAREST
LEGAL /� '
CROSS ST. C,94,•f 14.
DESCRIPTION LOT NO. OWNER
BLOCK TRACTSt?k6 MAIL
ADDRESS_
SIZE OF LOT �, � �,�-q`j"� N0. OF BLDGS.
NOW ON LOT CITY
USE OF
BUILDINGS _a.(7 DISTRICT NO. dROUP MAP
•y e _ I -I BK PG .
CONTRACTOR
ADDRESS P CONNECTION DATA —j
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CITY _ /'�d` TEL. NO.y- 4P 461 '0 S STATION DEPTH
` ElSTATE - ,® r 11AN ,$EFERENCE
REGISTRATION NO. / ,7 ❑ COUNTY .��_ /UPPEA LOWER
TYPEICSIi ECTION LENGTH FROM
No. DESCRIPTION OF WORK FEE Y. URB 8 P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO ad'i
D PUBLIC SEWER $ '3.50 Cil
HOUSE SEWER CONNECT114G TO
PRIVATE DISPOSAL SYSTEM 1.00
_
CONNECT ADDITIONAL BLDG. OR CO. IMP. NO. JOB. N0.
'WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
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
PERMIT CONNECTION CHARGE FEE
OWNER'S $ 1 00
AUTHORIZATION TOTAL FEE' REIMBURSEMENT FEE
I HAVE THIS.,DATE CONTRACTED WITH THE HEREIN NAM D N-
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DW LING APPROVALS DATE INISPECTOR'S SIGNATURE
TO THE PUBLIC SEWER ,�.�,,,
SIGNED THIS 0 42 !DAY OF A .��p 19'•l,'� NEW HOUSE SEWER
OWNER OR" "(�- 0 J�f p CONNECT ADDITIONAL
OWNERS AGENT1 Q�� >1z,J1s4l,A BUILDING OR WORK
C/`Ks J �- �X _ SEPTIC TANK, SEEP, PIT(S)
-
ADDRESS /'�—"--L�-- AND/OR DRAINFIELD
ID
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL[3 DRYWELL❑ _
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY '
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER, REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER 1
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SEEP:PIT(S) ❑ CESSPOOLS u. } ICSNLL•- --^�
SIGNATURE
OF PERMITTEE-
WILLIAM J. FOX,CO*Y ENGINEER VALIDATION
BY <,. B 4 43:n MAR� �. � 45-0
to
DEPUTY DEPUTY
'
By BY
'.® DEPUTYDEPUTY