HomeMy Public PortalAbout9833 HALLWOOD DR_Sewer__ •17 6 A E-2 D A P P I� 1t _A' X I®0 V tl ®R PERMIT
.5&E•663 12.54 tl"" U G &o �9 U V
DIVISION OF BUILDING ARID SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
J. FO 'of COUNTY
gelesENGINEER
BUILDING qt 33 "l
ADDRESS. 3
WM. J. FOX, COUNTY ENGINEER � ----, �-r--
CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
/
FOR APPLICANT TO FILL IN ceoss sr. E S
LEGAL ®
DESCRIPTION. LOT NO, A�•7 - OWNER /'?!J �-1 1����h/� 141
BLOCK �j�TRACT/ /�' MAIL
ADDRESS'r1931 _JG47,
SIZE OF LOT �:J C* j .�, NOWOO NBLOTS�' - / �f L. N0.
CITY
USE OF
BUILDINGS '�-' eq- - DISTRICT NO., - GR CrUPMAP
K PG9CONTRACTOR
ADDRESS / 9-- % - CONNECTIONI DATA
-oil
may"
CITY TEL. NO-4—L4 `Pi4 GLSDINDUSTRIAL
DEPTH
REGISTRATION N0. ❑ STATMANHOLE REFERENCE
LD 2.00
f1 ❑ COUNUPPER OWER
Ty OF'CONNECTION LENGTH FROM
NO. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO
PUBLIC SEWER I @ $ 3.50
HOUSE SEWER CONNECTING TO
------���ttt--- .PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR NO. JOB. N0.
-WORK TO HOUSE SEWER 1.00 ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 RMIT NO• ROAD P MIT NO.
DISCONNECT AND ABANDON SEWERCROACHME TAND/OR DISPOSAL SYSTEM 1.00 C-SEPTIC TANK, SEEPAGE PIT.ORO.
_I P�TS AND/OR L
CESSPOOL- DRYWELL G WASTE APPROVAL
,SPECIAL CONDITIONS ONLY 2.00 C ZRGES
$ t o0
OWNER'S
PERMIT CONNECTION CHARGE FEE
_
AUTHORIZATION. TOTAL FEE !i G' REIMBURSEMENT FEE
I HAVE NMED CON
TRACTOR TO CONNECT THEA
ABONTRCTEDVE DESCRIBED EXIISWITH THE TIINGA DWELLING APPROVAL ' TE INSPECTORS SIGNATURE
JO THE PUBLIC SE ER -
SIGNED THIS DAY OF_L1(LL1^ e19�5_-f NEW.HOUSE SEWER
CONNECT'ADDITIq-� AL
OWNER. 'OR- , '�',// -y� BUT
OR W RK
OWNERS AGENT").Z-�4� 2 ////" Ylt A^� � p W
ADDRESS /r, (_ - /4/G�/�A�L� y:?a_ 1+CA,n,/j9. AND/ORTDRAI FIELYEEPD PIT(S)
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION .`y CESSPOOL DRYWELL E3AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY./
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER, PAIR,SEWER OR
ISPOSAL SYSTEM.
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCO SEWAG NECT PLUG AND
A
LICENSED AS REQUIRED BLOS ANGELES COUNTY Al OF ABA ON.HOUSE SEWER _
CALIFORNIA. OR THAT. 1 AM THE LEGAL OWNER OF THE THE'ABOVE
DESCRIBED RESIDENT AL P OPERTY.,- BA FILL SEPTIC TANKS❑
P:PITS) ❑ CESSPOOLS❑
SIGNATURE -
OF PERMITTEE
LIAM J. FOX,COUNTY ENGINEER VALIDATION
tf
BY _
DEPUTY DEPUTY
BY
DEPUTY ���G�`�T'� ✓ ��r DEPUTY