HomeMy Public PortalAbout9829 HALLWOOD DR_Sewer__ APPLO
AT�ON FOR PERMIT
CE808.8-88 C
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER s .,. ,
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS b VdCti
CASSATT D. GRIFFIN, Sup't of Building LOCALITY Ze-
nw NEAREST
FOR APPLICANT TO FII1 IN• CROSS ST.
LEGAL
DESCRIPTION LOT NO. OWNER
BLOCK TRACT /1 MAIL
(1 ADDRESS `w 6 en R
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY !L .N0. 1 (Ci O �^� ?•
USE OF �f z
:n BUILDINGS . "DISTRICT NO. GROUP MAP PROCESSED BY
CONTRACTOR �^ K -7 -g i
w ADDRESS >, CONNECTION DATA
r CITY 'TEL.NO. STATION a L5DEPTH
STATE
REGISTRATION NO. 1 ® COUNTY " �t o UPPER
MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE Low
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 TYPE OFTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR f Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD -
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
0. PRIVATE DISPOSAL SYSTEM @ $1.00 % CO.IMP.NO JOB.NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.,
'A. WORK TO HOUSE SEWER @ $1.00
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 _ PERMIT NO. -
INDUSTRIAL
WASTE APPROVAL"
CHARGES -
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION I TOTAL FEE < cpio REIMBURSEMENT FEE -
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19— NEW HOUSE.SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PITS)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT [ HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 -HEREBY 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 I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE=PkO BACKFILL SEPTIC TANKS'❑ �SIGNATUREF SEEP.PIT(S) El
OF.PERMITTE -
®r AIMATION ROBERT A.WOOD
Ita ;
if.g, CASH `SUPlaRV1SING'MECHANICAL ENGINEER