HomeMy Public PortalAbout10321 FREER ST_Sewer__ > 7GA642D APPLICATION- FOR PERMIT 7
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DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL. �
Department of County Engineer �—
County of LOS AngeleB BUILDIGADDRESS/ /
WM.J. FOX. COUNTY ENGINEER
CASSATT.D. GRIFFIN,•SUP'T OF BUILDING LOCALITYL,-.LC/�Y/ �
FOR APPLICANT Y.Q FILL IN NEAREST
CROSS ST.
V'
LEGAL 4.3
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DESCRIPTION LOT LA0. c' 4- OWNER _
BLOCK TRACTZ/,k!i ,lK AMAIL
DDRESS
O
SIZE OF LOT NOW ONBLOTSr'
CITY �/ y t� TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP P
PG
MA
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CONTRACTOR( ! /
i
2-1
ADDRESS TCONNECTION DATA
CI_TY1) ',AP�� TEL. NO. STATION 0 -f-1./�/ DEPTH 2
❑ STATE MANHOLE REFERENCE
REGISTRATION NO. , J 9 Y %/• Cl COUNTY- �� LOWER
w000 l- TYPE OF CONNECTION LENGTH'FROM
NO. DESCRIPTION OF WORK FEE Y. CURB P.L. M.L.TO P.L.
E HOUSE SEWER CONNECTING TO ,/rte✓
_ PUBLIC SEWER Q $ 3.50
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR r
CO. IMP. LA0.
WORK TO HOUSE SEWER 1.00 JOB. NO.
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
_
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
__AND/OR DISPOSAL SYSTEM _ 1 00 PERMIT NO.
SEPTIC TANK, SEEPAGE PIT OR
PITS AND/OR DP.AINFIELD 2.00 INDUSTRIAL
CESSPOOL- DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES
_ CONNECTION CHARGE FEE
OWNERS PERMIT g 1 00
AUTHORIZATION TOTAL FEE yo REIMBURSEMENTS FEE
TRACTORHAVE T TO DATE CONNECT THECTED WITH THE ABOVE DESCRIBED EXISTING HEREIN NAMED DWELLING - APPRO V ALS DATE INSPECT R S SIGN RE
TO THE PUBLIC SE R
NEW HOUSE SEWER
SIGNED THIS DAY OF n 19
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT* BUILDING OR WORK
( I SEPTIC TANK
ADDRESS , SEEP, PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLED E T AT 1 HAVE READ THIS A LIGATION CESSPOOL❑ DRYWELL[IAND STATE THAT THE AB VEIS CORRECT AND AGREE TO COMPLY _
WITH ALL COUNTY OR )I LACES AND STATE LAWS REGULATING ALTER, REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEW DISCONNECT PLUG AND
D
CALIFORNIA OR THAT I M THE LEGAL OW OF THE ABOVEER
DESCRIBED RESIDENTIA OPERTY. BACKFILL SEPTIC TANKS❑
SEEP. PIT(S) ❑ CESSPOOLS❑
• SIGNATURE
OF PERM
WILLIAM J. FOX, COU Y ENGINEER VAL DATION ,y
-B7 ...J�Co BY�7 .Q. CIO`l AUG 17 4 4.5 0 :In
' DEPUTY � DEPUTY
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