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HomeMy Public PortalAbout10516 FREER ST_Sewer__ ESOB-0 C8.58 APPLICATION F®R PERMIT EBOB• COUNTY OF LOS ANGELES SEWER-SEWAGE ®9SOOSAL DEPARTMENT OF COUNTY ENGINEER - - BUILDING AND SAFETY DIVISION BUILDINGADDRESS 1 I'® (e JOHN A. LAMBIE, County Engineer _ �^' CASSAIT D. GRIFFIN, Supt of Building LOCALITY G� L. �r C T iF cNEAREST. /�{ ,✓ (�� �J DESCRIP ION LOT N0. .`� py`" OWNERS D!/I�/ d. /.)C f/©/�� �( •l BLOCK TRACT CIMAIL NO.OF ADDRESS J �(� SIZE OF LOT NOW ON LOTS CITY r TEL.NO. •�/ 7J / USE OF BUILDINGS. DISTRICT NO GROUP MAP PROCESSED BY _ HK P6 CONTRACTOR ADDRESS CONNECTION DATA roye / t CITY N0. STATION �--� DEPTH STATE MANHOLE REFERENCE ,il,/ REGISTRATION NO. ® COUNTY rd' LOWER NO. DESCRIPTI N OF WOR FEE HOUSE SEWER CONNECTING TO - PUBLIC SEWER @ $3.00SEPTi TYPE OF CONNECTION,-05s, LENFROM PITS IAND/OR DRAENFIELDT E PIT OR @ $g 00 - Y. CURB P, M.L.GTH TO PF.L. -� OVERFLOW SEEPAGE PIT, DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $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 N0. ROAD PERMIT N0 WORK TO HOUSE SEWER @ $1.00 . - ALTER, REPAIR OR ABANDON HOUSE - STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. ti INDUSTRIAL WASTE APPROVAL ' CHARGES OVPmws PERMIT 8 2 00 CONNECTION CHARGE FEE AUTHORIZATION I TOTAL FEEREIMBURSEMENT FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. 'APPROVALS DATE INSPEC GNATURE TRACTOR TO CONNECT'THE ABOVE DESCRIBED EXI NG DWELLING rTDR=S=SIa. TO THE PUBLIC SE R — SIGNED THIS ­U — NEW HOUSE SEWERV-P ~ OWNER OR CONNECT ADDITIONAL v OWNERS AGENT X BUILDING OR WORK SEPTIC TANK;SEEP, PIT(S) ADDRESS AND/OR DRAINFIELD I HEREBY 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 I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGE COUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I AM THE LWL OWNER OITH -ABOVE - DESCRIBED RESIDENTI ROP BACKFILL SEPTIC TANKS SEEP.PITS) ❑ CESSPOOLS SIGNATURE OF PERMITTEE VALIDATION ROBERT A.WOOD cK. Id,o. CASH -+ SUPERVISING MECHANICAL,ENGINEER kn- 5.00