HomeMy Public PortalAbout10325 FREER ST_Sewer__ E-6D APPLICATION FOR P
JS 1
S&8420 ERMIT
I1-SS•
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County.Engineer pts
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR-APPL C NT TO IN CROSS ST. 6
LEGAL
DESCRIPTION LOT NO�Z 01, OWNER _
Q� MAIL
BLOCK TRACT 7 ADDRESS•
N0.6F BLDGS. CITY TEL. IJ O.
SIZE OF LOT NOW ON LOT
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
J
(7 BK PG
CONTRALTO
ADDRESS -
CONNECTION DATA
STATION ® DEPTH
CITY TEL. N0.
'MANHOLE REFERENC 6 esT UPPER
STATE
REGISTRATION NO. /jam ❑ COUNTY
NO. DESCRIP I 0 WORK FEE - TYPE OF CONNECTION LENGTH FROM
HOUSE SEWER CONNECTING TO <s Y. CURB P,L. M.L. TO P.L. O
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD Oq P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. (�Y JOB NO. `
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD'PERMIT NO. A)
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT_
WORK TO HOUSE SEWER a $1 00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL -
SEWER OR DISPOSAL SYSTEM a $100 WASTE APPROVAL
CHARGES
_ CONNECTION CHARGE FEE-
OWNER'S PERMIT $ 1 00
- REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE
I HAVE 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 PUBLICS R. NEW HOUSE SEWER C"
SIGNED THIS AY I9 CONNECT ADDITIONAL '
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S) '
ADDRESS AND/OR DRAINFIELD -
I HEREBY ACKNOWLEDG AT 1 HAVE READ THI AP LICATION CESSPOOL❑ DRYW ELL❑ '
AND STATE THAT lHE ABOVE IS CORRECT AND AGR O COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I 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 LEG OWNER OF THE ABOVE
DESCRIBED RESIDENT! PROPERTY. BACKFILL SEPTIC TANKS[] '
SIGNATURE T
SEEP. PIS) ❑ CESSPOOLS ET
OF PERM ITTE,_
11
JOHN A. LAMBIE. Co TY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
CK. M.0. CASH '