HomeMy Public PortalAbout9834 HALLWOOD DR_Sewer__ . D
S&E-663 12-54 APPLICATION . FOR PERMIT
5&E•6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
-' Departj'an
t of County Engineer
(.. Cy of Los Angeles BUILDING_
WM.JX, COUNTY ENGINEER ADDRESS
CASSATT RIFFIN,SUPT OF BUILDING LOCALITY
FOR.APPLICANT TO FILL IN NEAREST ��, �.
CROSS ST.
LEGAL
DESCRIPTION___ LOT NO. -
OWNER
BLOCK TRACT{ NO. 6F L.� MAIL
BADDRESS f��
_SIZE OF LOT " �. N,WON LOTS �� CITY �// C C,/fT L. N0. T
B OF
U.USEL.INGS ��•�� •,I `' 1 J- �< /L• DISTRICT NO. GROUP MAP
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CONTRACTOR -yy,/•`" C� • c/
ADDRESS CONNECTION DATA
CITY TEL. NO.,vt_ 69'GI4 44.4'e9
,/Ye9 b STATION 3 :t---?7, DEPTH
- ❑ STATEM ,UPPER FERENCE 1'�SE£it
REGISTRATION NO. � U"♦ / ❑ COUNTY
c SIE,
P
JJ✓ ! - TYPE OF CONNECT LENGTH FROM 7
No. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L.
HOUSE SEWER CONNECTING TO G`
PUBLIC SEWER @ $ +3.50 3
HOUSE SEWER"CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR
WORK TO HOUSE SEWER. 1.00 CO. IMP. N0. aJOB. NO. f Q
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 � TRUNK PERMIT N0. _ ROAD PERMIT N0. 7 0
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
u
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 _00
AUTHORIZATION TOTAL FEE �b, 'fy REIMBURSEMENT FEE
TRACTORHAVE T TOS CONNECTDATE ONTRTHEA ABODVE DESCRIBED THE H
ESCRBEDY EXISTING NAMED
DWELLINGAPPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEW% R ,/)A ,/� yG�
SIGNED THIS— —6 DAY OF19J�� NEW'HOUSE SEWER
OWNER ' OR !I-7/ -CONNECT ADDITIONAL
OWNERS AG NT . ""L BUILDING OR WORK
'� - - SEPTIC TANK, SEEP, PITS)
ADDRESS - AND/OR DRAINFIELD '
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE-THAT THE ABOVE IS CORRECT AND AGREE TO C014PLY _
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS.
SEWAGE DISPOSAL SYSTEM -
IHEREBY CERTIFY THAT 1 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 RESIDENTIAL PROP RTY. BACKFILL SEPTIC TANKS❑
/ + SEEP.PIT(S) ❑ CESSPOOLS 3 L3 7'3 -4JJCJ:,t1,•.,- ,
SIGNATURE �i,/� a•-�- - �� -
OF PERMITTEE - - '
WILLIAM J. FOX�COUNTY ENGINEER VALIDATION
1 2 1`7.x.. �R
BY I BY /jam - 45.0
DEPUTY '%/ `///�.��•�.✓ DEPUTY
.By BYr
,•® DEPUTY DEPUTY