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Home My Public Portal About10510 FREER ST_Sewer__ TEMPLE CHTY ES08 ° Cltaoe APPLICATION FOR PERMIT a-sa COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING .rr�� ADDRESS �� .�4y. t JOHN A. LAMBIE, Count Engineer CASSATT D. GRIFFIN. Sup t of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL 1,� �/ � � �� s � DESCRIPTION LOT NO.�J�„�.91�� ✓ �'r�"� OWNER Yom.✓ f ,- �J��%�d BLOCK TRACT ffy`1C� A DRESS �f JdMAIL •_� NO.OF BLDGS. n. _ SIZE OF LOT NOW ON LOTCITY,• - EL. NO. USE OF p / BUILDINGS ��2 DISTRICT N0. ROUPMAP I PROCESSED BY r I_ BK PG CONTRACTOR ADDRESS➢/ — / CONNECTION DATA CITYf,?.�- :" l TEL.NO, �jr—�� y STATION370 DEPTHAA REGISTRATION N0. /� VSTATE COUNTY MAN OLE REFFj'ENCE _ LOWE NO. DESCRIPTION OF WORK FEE p HOUSE SEWER CONNECTING TO *sem 4 PUBLIC SEWER @-0,08- t��✓ TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR t Y. C4JRB P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD v 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. INDUSTRI WASTE AP m CHARGES OWNER'S PERMIT $ 2L�O CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE °y 0 REIMBURSEMENT FEE I .N HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON- TRACTOR TO CONNECT T VE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS I DAY, 19_ NEW HOUSE SEWER OWNER OR �� CONNECT ADDITIONAL OWNERS AGENT BUILDING OR WORK +. ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD 1, HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SAND 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 1ICHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT AM THE LE OF THE ABOVE DESCRIBED ROR TH PROPER / BACKFILL SEPTIC TANKS ❑ SIGNATURE A SEEP,PIT(S) ❑ CESSPOOLS OF PERMITTE :p� - •,��'�✓/✓� ®r VALIDATION ROBERT A. WOOD M.o. CASH SUPERVISING MECHANICAL ENGINEER LACO 8803 AUG 12 10D 7.00 TEMPLE CIT CE808 B-89 APPLICATION FOR PERMIT E80B 9 7 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION Bu1LDING y.J ADDRESS JOHN A. LAMBIE, County Engineer CASSATT D. GRIFFIN. Supt of Building LOCALITY F j==jNEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL •+ r •� ' DESCRIPTION LOT NO s� /~��.%Li OWNER �( BLOCK - TRACT %/• ,� MAIL p DR ESS _ �,t NO.OF BLDGS. l �, SIZE OF LOT NOW ON LOT CITY f�"t �/`_ s 'ffEL. NO. USE OF NO. GROUP CESSED BY BUILDDINGS DISTRICT MAP PRO �t" I BK P �G CONTRACTOI R�� S ADDRESS ,,> Y r.� CONNECTION DATA ^� CIT�yi�{2�� EL.NO. >' T STATION ( 3 7 ®. P vs i R�$ — MANHOLE REFERENCE REGISTRATION NO. Jy ❑ COUNTY pyy NO. DESCRIPTION OF WORK FEE USE SEWER CONNECTING TO PUBLIC SEWER C'° $9-6'0 TYPE OF CONNECTION LENGTH FROM / SEPTIC TANK,SEEPAGE PIT OR Y. P.L. M.L.TO P.L. PITS AND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL. DRYWELL @ $2.00 HOUSE SEWER CONNECTING TOP. .NO. PRIVATE DISPOSAL SYSTEM @ $1 00 CO.IMP.NO. J B NO. CONNECT ADDITIONAL BLDG.ORTRUNK PERMIT NO. ROAD PERMIT NO ! /f WORK TO HOUSE SEWER @ $1.00 ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYST @ $1.00 PERMIT NO. G1 I INDUSTRIAL /) WASTE A 0 v CHARGES OWNERS PERMIT 1,0 0 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXIST G DWELLING APPROVALS DATE INSPECTORS SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY F 19_ NEW HOUSE SEWEROWNER OWNER AGENT ,J��'. CONNECT ADDITIONAL C v cam= BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT IHAVE 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 AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THA `IAM THE LEG - OWNEOF THE ABOVE DESCRIBED RESIDEN L ROPERTY .r/ BAC KFILLSEPTIC TANKS SIGNATURE ❑ SEEP. PIT(S) ❑ CESSPOOLS ❑ OF PERMITTE .��.� ®rVALIDATION ROBERT A. WOOD • M.o. CASH SUPERVISING MECHANICAL ENGINEER LAj;gB,8 af4w%0'l AU91.2i i o 2 5-00- .. _.. .. . ISA �• �-