HomeMy Public PortalAbout10525 FREER ST_Sewer__ TMENT of COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 1
J ON OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
FOR APPLICANT TO FILL IN LOCALITr—'T'� C i
BUILDING NEAREST
ADDRESS I CROSSST,
LOCALITY�� �/ d 1 } DISTRICT NO. SERIAL N0. +QPER_gMIT NO. C
NEAREST L1 X DR ��aI A (RGFk . .S
CROSS ST. _
T RECEIVED BY Ready for Inspection !DATE ISSUED,
OWNER `P�'�
MAILo s � �
ADDRESS �e � � USN9 I OCCUPANCY I BK MpP PG
Cif j'A4 (:A TyTEL NO - --
CONTRACTOR -4a-.*.4-- CO.IMP.NO. Z/9 _
r e
ADDRESS v� � p ,vl�t A ,�' . JOB.NO.
CITY w N �� TRUNK PERMIT NO.
REGISTRATION NO! �, �,g�_�•��04 ® COUNTY ROAD PERMIT NO•
LEGAL ee STATE ENCROACHMENT,
DESCRIPTION LOT NO. 9 PERMIT NO.
BLOCK a TRACT 11�Q® WASTETRIAL
APPROVAL'�
SIZE OF LOTVP NOW ON LOTBLDGS 'I-, CHARGES
USE OF ` � ..► CONNE TCTC ION•CHARGE FEE
BUILDINGS !J
NO. DES RIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLICSEWER @ ; 3.50 RECEIPT N0. DATE� "'� BY
HOUSE SEWER CONNECTING TO �`
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR _EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0.
ALTER OR REPAIR EXISTING I DATE I BY ��• \
SEWER OR DISPOSAL SYSTEM 1.00 \+.
.DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA-
SEPTIC TANK,SEEPAGE PIT OR f
PITS AND/OR DRAINFIELD 2.00 STATION ' 'Z.t Q d DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 I Arll! EFERENCE �>
p �1PPER}' R:
[:NEW
PE OF CONNECT IO.N�� LENGTH FROM
OWNERS PERMIT I I 00� EM.L.TO P.L.AUTHORIZATIONI TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMEDCONTRACTOR TO CONNECT THE ABOVE•DESCRIBED EXISTINGPPROVALS INSPECTOR'SSIGNATURE DATE
DWELLING TO_THE PUBLIC SEWER
SIGNED THIS_.. _ ..___DAY OF.._1- "' _______.I9 OUSE SEWERECT ADDITIONALOWNER OR 1f �fyAJ�� ING OR WORK
OWNERS AGENT_. !�. !- ! ed' -_rADDRESSLl _ __ .____ .... .�aFo- ___. C TANK,SEEP.PITS)S _ L+ __�_ ._L_. .�_._. OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS'APPLI- ' CESSPOOL� DRYWELL
CATION 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
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS N,GEL-ES-'COUNTY ABANDON HOUSE. AND
AND STATE OF CALIFORNIA OR THAT I HE LEGAL OWN-
ER• A THE ABOVE D�, ES TIAL PROPERTY. 'BACKFILL SEPTIC TANKS El
S
SIGNATURE 1 SEEP.PIT(S)� CESSPOOLS
OF PERMITTEE - f' - �F_ iY.��a.
76A642A 663 7/53