HomeMy Public PortalAbout10243 FREER ST_Sewer__ a v
10-63
76AZ'42D APPLATIO =FORERMI
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION FA
LDING Q
JOHN A LAMBIE, County Engineer RESSWILLIAM A. JENSEN, Sup't of Building /�ALITYC..r {RESTFOR APPLICANT O FILL IN 7 SS ST
LEGAL
DESCRIPTION LOT NO OWNER
MAILg`A
BLOCK TRACT �- / 09 ADDRES ,
O OF BLDGS
SIZE OF LOT NOW ON LOT CITY C TEL NO
USE OF
BUILDINGS DISTRICT NO GROUP MAP PROCESSED BY
CONTRA 3/ f/ s _r -5 /l Pgi , A
ADDRESS -;I- CONNECTION DATA
TATION DEPTH
CIT r TEL 7
TATE MANHOLE REFERENCE UPPER
REGISTRATION NO ElCOUNTY ^ LOYLGF�..
NO DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM _-1HOUSE SEWER CONNECTING TO � Y CURB P M L TO P L
PUBLIC SEWER @ $5 00
SEPTIC TANK SEEPAGE PIT OR J C NO /
PITS AND�OR DRAINFIELD @ SIO 00 CO IMP NO OB NO I` V
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO
PRIVATE DISPOSAL SYSTEM @ $300 ^
CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE 0
WORK TO HOUSE SEWER @ $300 V
OVERFLOW SEEPAGE PIT DRAINFIELD L!J
EXTN CESSPOOL DRYWELL MANHOLE @ $500
ALTERREPAIR OR ABANDON HOUSE HWY OR ST WIDENING h
SEWER OR DISPOSAL SYSTEM @ S3 00 STATE ENCROACHMENT
PERMIT NO
INDUSTRIAL
WASTE APPROVAL
OWNERS PERMIT 2 00
CONNECTION CHARGE FEE CHARGES
AUTHORIZATION TOTAL FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED!/CONN REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR S SIGNAT E
• SIGNED THIS DAY F 19_
OWNER OR NEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK SEEP PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITHALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑
I HEREBY CERTIFY THAT I AM PROPER ISTERED AND/OR ALTER REPAIR SEWER OR
LICENSED AS REQUIRE BY LOS ANGL COUNTY AN STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TH AM THE LEGA O ER OF INTEND TO DISCONNECT PLUG AND _
RESIDE IN THE O DESCRIBED ESIDE IA OPERTY ABANDON HOUSE SEWER
SIGNATURE
OF PERMIT Ij6C5FILL SEPTIC TANKS ❑
SEEP PIT(S) ❑ CESSPOOLS ❑
VALIDATIO��) ROBERT A wood
SUPERVISING MECHANICAL ENGINEER
CK M O
I. x 1 2 3 5 JUL 13 1 0 a 7.00- IN