HomeMy Public PortalAbout10511 FREER ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER--SEWAGE DISPOSALI 145
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FDX, COUNTY ENGINEER ;I BUILDING /� „//
{ ADDRESS L J
FOR APPLICANT TO FILL IN LOCALITY
BUILDING /� / d- NEAREST U
ADDRESS // CROSS ST.
LOCALITY DISTRICT NO. VSERIAL NO. PERMIT N0.
NEAREST 1 5 A �� S
CROSS ST. ��
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER (/
h "MAIL USE ZONE OCCUPANCY MAP 1
w ADDRESS /I I I BK PG
CITY TEL.NO. L1
CONTRACTOR California Sewer Const.Co CO.IMP.NO. SL��
ADDRESS 1317 Cole rove Ave.
=3 g -- JOB.NO.
< CITY Montebello TEL.No. UNion 1-504`
TRUNK PERMIT NO.
REGISTRATION NO. 104445 ROAD PERMIT NO. _
LEGAL STATE ENCROACHMENT
,DESCRIPTION LOT N0.,11 PERMIT N0.
BLOCK TRACttT //�� INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT K l lb NOW ON LOTSCHARGES
No OF T�
USE OF
n /J
BUILDINGS -I�Wtl CONNEC OTI N'CHARGEFEE
NO. DESCRIPTION OF WORK FEE -
REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
f y / PUBLICSEWER Q $ 3.50 /
_T RECEIPT NO. /I DAJE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR _
PITS AND/ORDRAINFIELD 2.00_ STATION � 7� S
CESSPOOL—DRYWELL � DEPTH
SPECIAL CONDITIONS ONLY 2.00 / MANHOLE-REFERENCE
-IdPRFia V/ pL LOWER
TYPE OF CONN ECTILENGTH FRO
Ctl• PM.L.TO P.L. '�
RfB 5�
OWNERS � PERMIT $ 1 1 00
AUTHORIZATION TOTAL FEE•
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS I NSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER Q
SIGN THIS__ o_ DAY OF-.-.- i-L�.�._.--19_,5 NEW HOUSE SEWER +�. r- � -
CONNECT ADDITIONAL
OWNERS AGOWNER ORENT�_.- .____ __ 0E.1 / BUILDING OR WORT(
= 0 �"•1
' / �/� -• �' SEPTIC TANK,SEEP.PIT(S)
:'. ADDRESS-- - F--�� F1 !Z..{° E` - ... --s.......... AND/ORDRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOO ,� DRYWELL
CATEE
ION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL-SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED . DISCONNECT
AND/OR L.CENSED AS REQUIRED BY LOS ANGELES COUNTY AND
ABANDON HOUSE PLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN SEWER
-
y �7+ER OF THE ABOVE DESCR ED R SIDENTIAL PROPERTY. BACKFILLSEPTICTANKSEi �q
, �. SEEP.PIT(S)� CESSPOOLS
_ l
•,SIGNATURE
^e _• OF PERMITTEE - -.......... .:.
PY'itid642D, 663 1/53 O
D
5&E-683 11.55 APPLICATION FOR PERMIT 1
8&E•8
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Department of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL �r^ OWNER
DESCRIPTION LOT N0. ! • '
MAIL /
BLOCK TRACT ADDRESS
NN1�1
F BLDGS. CITY TEL.SIZE OF LOT - ON LOT
USE OF
BUILDINGS DISTRICT NO. GROUP MAP
_ BK PG -
CONTRACTOR - '
ADDRESs`Sr�0!4 d!!5 .�,� /— 'w CONNECTION DATA
CITY / ?;/6ELt.�NO. ������` STATION DEPTH
[C' MANHOLE REFERENCE UPPER
STATE LOWER
REGISTRATION N0. ��,� ❑ COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNE ON LEN H FROM
Y. CURB P.L. M. .TO P.
L.
PUBLIC SEWER @ $3.50 '
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE n $2.00 CO. IMP. NO, _ J NO.
HOUSE SEWER CONNECTING TO n `
PRIVATE DISPOSAL SYSTEM $100 TRUNK PERMIT NO. ROAD MIT NO. /
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHM T
WORK TO HOUSE SEWER @ $1.00 PERMIT NO
•ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL•SYSTEM Q $1.00 J �! D - WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT 8 1 00
AUTHORIZATION TOTAL FEEREIMBURSEMENT FEE
.Z i0c
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 PUBLIC SEWER NEW HOUSE SEWER '
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD -
P HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT .THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
i
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM ' -
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND t V r v
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HO PLUGAUSE D
CALIFORNIA OR THAT M THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI P OPERTY, f BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG INSPECTOR
CK. d.0. ASH -
,. .2-3.9 4D; SEP