HomeMy Public PortalAbout10508 FREER ST_Sewer__ 7BAS42D
CES08 9.56 APPLICATION FOR PERMIT -
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1
DEPARTMENT OF COUNTY ENGINEER
B IIIBUILDING AND SAUILDING
FETY DIVISION ANG
DDRE S
IOHN A. LAMBIE, County gweer
LD'
CASSATT.D. GRIFFIN. SupF of Building LOCALITY
NEAREST e
. FOR APPLICANT TO FILL IN CROSS Sr.
LEGAL
/�/ /
DESCRIPTION. LOT NO.y .'-6 A OWNER •�fi ...j� j
BLOCKMAIL
TRACT, r-r
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS ^C�'� _ _ DISTRICT NO. GROUP '
MAP PROCESSED BY
BK PG
CONTRACTOR ,,.�t'.�./�� � J_
ADDRESS Lsr CONNECTION DATA
TEL.N0. ���f STATION d. �I DEPTH "e -
' �- STATEff
MANHOLE REFERENCE UPPER
REGISTRATION N0. ��[S S - COUNTY ,GxL - yvytli�6
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 C_ C TYPE OF CONNECTIO LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB M.L.TO P.L.
ITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD _
EXTN..CESSPOOL. DRYWELL @ $
2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. JOB NO.
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. ROAD PERMIT NO.
WORK TO HOUSE SEWER @ $1.00 '
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO.
INDUSTRIAL "
WASTE APPROVAL
CHARGES
OVVMR'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEES �0 REIMBURSEMENT FEE
I HAVE AT DATE A CONTRACT WITH THE- CON-
TRACTOR TO CIONNECT THE ABOVE DESCRIBED EXIISTIJNGAMED DWELLING APPROVALS DATE - INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWE
SIGNED THIS DAY OF 19�Dd NEW HOUSE SEWER
OWNER OR ^� � CONNECT ADDITIONAL - -
OWNERS AGENT -� BUILDING OR WORK
ADDRESS � �� SEPTIC TANK,SEEP.PIT(S)
AND/OR DRAINFIELD
IH
ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR '
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HEREBY 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 1 AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENT! ^PROPERTY. BACKFILL SEPTIC TS ❑ K.•�
SLGNATURE1119 SEEP. PIT(S) ElCESSANKPOOLS
C]
OF PERMITTEE
Or VALIDATION ROBERT A.-WOOD -
S Y o CASH SUPERVISING MECHANICAL ENGINEER
1, � O00w itFR 71 O R 5.00 K
1