HomeMy Public PortalAbout10529 FREER ST_Sewer__ 78BOB t A 14 P OCA II M N FOR Il E R II V T �7
CE808 �-98 1111 00 LL�� tl
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER - -
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS
JOHN A. LANBIE, County Engineer f,j s• . e�`/v 1G+ /� _ l
CASSATT D. GRIFFIN, Supt of Building LOCALITY �r�� '�1 i, �7, C --' r
.,4 + NEAREST
FOR APPLICANT TO FILL IN CROSS ST. _
LEGAL
DESCRIPTION LOT N0. i OWNER a 7�n-�A
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS. v I
SIZE OF LOT NOW ON LOT CITY 1 TEL. NO.
•� USE OF
BUILDINGS �--^-� q a DISTRICT NO.� GROUP MAP P CESSED BY
BK PG
CONTRACTOR
ADDRESS —9 Q`,, /^ �o n C NECTION ATA
CITY TEL).N0. ^�t- STATION D PTH
_ � � � ,�" ❑ STATE - MANHOLE REFERE CE ��) p/y UPPER
REGISTRATION N0. /J �J ❑ COUNTY g e jk eL/ LOWER
NO. DESCRIPTION OF WOE""l/F9E / p
HOUSE SEWER CONNECTING TO iZe6 0,7
'^ PUBLIC SEWER Co') $3.00 TYPE OFC NNECTION JV LEN FR6M
SEPTIC TANK,SEEPAGE PIT OR Y. CURB P.L. M.L.TO P.L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.. CESSPOOL.DRYWELL P..$2.00 g
P.C.
HOUSE SEWER••CON NECTING TO
PRIVATE DISPOSACSYS @ $1.00 CO.IMP. N0. J 0.
CONNECT ADDITIONAL BLDG. TRUNK PERMIT N0. D PERMIT N0.
WORK TO HOUSE SEWER @ $1.00
ALTER,R D 3RO R ABANDO
SYSTEM HOUSE @ $1 OO STATE ENCROACHM
PERMIT NO.
INDUSTRIA
_ WASTE Ae^OVAL
CHARGES
OWNER'S PERMIT $ 2 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
'LIHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON-
T RACTOR
ON-TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING :.` APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER:
SIGNED THIS AY OF / r� = f 19'^ 1111
�' NEW HOUSE SEWER
��-
CONNECT ADDITIONAL
OWNER OR / _
OWNERS AGENT d"-�'^ � A��� /? BUILDING OR WORK `«
ADDRESS 'Y" V ! v , T- SEPTIC TANK,SEEP.PIT(S)
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
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF - ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY.� _ BACKFILL SEPTIC TANKS ❑
[:1SIGNATURE
i% .{� SEEP. PIT(S) CESSPOOLS ❑
,. ,
OF PERMITTEE
®� VALIDATIO ROBERT A. WOOD
CK. R.0. GASH SUPERVISING MECHANICAL ENGINEER