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Home My Public Portal About10535 FREER ST_Sewer__ Y 10.82 76A642D APPLICATION FOR PERMIT 78A 84 - COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION Frl! %��✓�— �Y�� JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Sup't of Building �� / .. 14 Ll FOR APPLICANT TO FILL IN LEGAL DESCRIPTION LOT NO. OWNER /s 56?,- MAIL / BLOCK TRACT / r ADDRESS �+♦ � r�.�/ NO OF BLD GS. SIZE OF LOT NOW ON LOT CITY lir/» /C? 6?/1i7FEL. NO. USE OF t ` „/�ne� BUILDINGS J f U ��' �J DISTRICT NO. :GaROUP MAP PROCESSED BY BK PG CONTRACTOR ADDRESS �'3dV,-/�' �/t� �l/Qys�i Q/y�'G� C CONNECT ON ATA CITY ��'W ino% TTEL NO-0Z1-'5_- �'/qg STATION DEPTH REGISTRATION NO ��.' G9STATE MANHOLE REFERENCE - UPPER COUNTY LOWER •NO. DESCRIPTION OF WORK FEE TYP F CONNECTION LENGTH FRO d HOUSE SEWER CONNECTING TO Y URB P.L M L TO P.L O PUBLIC SEWER @ $5 00 0 P C NO SEPTIC TANK,SEEPAGE PIT OR CO IMF�O. l,J� JOB NO PITS AND/OR DRAINFIELD @ $10 00 � HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO O PRIVATE DISPOSAL SYSTEM e° $300 V CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NOT DATE Il.l WORK TO HOUSE SEWER @ $3 00 ®0 d OVERFLOW SEEPAGE PIT,DRAINFIELD N EXTN,CESSPOOL,DRYWELL,MANHOLE @ $5,00 HWY OR ST WIDENING ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL - OWNERS PERMIT $ 2 Oo CHARGES AUTHORIZATION TOTAL FEE �7 40V CO TION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTORTO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER DOWNERS AGENT )) CONNECT ADDITIONAL ADDRESS BUILDING OR WORK 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PITS) ,AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY AND/OR DRAINFIELD ,WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1 HEREBY CERTIFY THA I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRE B LOS ANGLES TY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT AM THE LEG ER O AND INTEND T DISCONNECT PLUG AND - RESIDE IN, THE AB D CRIB RE TI OPERTY. ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE- BACKFILL SEPTIC TANKS ❑•. SEEP,PIT(S) ❑ CESSPOOLS ❑- - • - VALIDATION ROBERT A. WOOD M O CASH SUPERVISING MECHANICAL ENGINEER CK N. L!kC:0 4 4 5 5 JAN 15 1 0 D 5.0.0 r � O_82 7GA642D APPLICATION FOR PERMIT � 8A842 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FCR ING JOHN A. LAMBIE, County Engineer SS .�-ro�✓r„3 /� �+ /� WILLIAM A. JENSEN, Sup't of Building ITY /G/77 ST FOR APPLICANT TO FILL IN ST. LEGAL 7 DESCRIPTION LOT NO. y OWNER �d�n �G�m�r ✓ 'GSSG/' MAIL BLOCK � TRACT //,;z yO ADDRESS NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF r -f BUILDINGS T+C's/G+'C/7G!' Y-Q/A41a DISTRICT NO. GROUP PG BK MAP PROCESSED BY .R CONTRACTOR �� ADDRESS CITY 1rlvi/VPq4A/G TEL. NO. 44`0'5' 9� STATION / - /J t� DEPTH TATE MANHOLE REFERENCE ��/ .G'`l UPPER REGISTRATION NO. �f0 3G�^+' COUNTY ��_ �' _ a NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION -- LENGTH F-OM O HOUSE SEWER CONNECTING TO Oo Y. CURB ,P.L. M.L.TOP Y V PUBLIC SEWER $5.00 - SEPTIC TANK,SEEPAGE PIT ORP,C,NO, PITS AND/OR DRAINFIELD @ $10.00 CO. IMP.NO. ` JOB NO. O HOUSE SEWER CONNECTING TO (- TRUNK PERMIT NO. ROAD PERMIT NO. U PRIVATE DISPOSAL SYSTEM @ $3.00 bjj CONNECTADDITIONAL BLDG.OR AFFIDAVIT WAIVER EAE[NE NT RECORD.INSTR.NO. DATE d WORK TO HOUSE SEWER @ $3.00 N OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT S 2 00 CHARGES AUTHORIZATION I TOTAL FEE AO CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWS� T DATE, INSPECTOR'S SIGNATURE SIGNED THIS / DAY OF OWNER OR NEW HOUSE SEWER OWNERS AGEN CONNECT ADDITIONAL ADDRESS / 3S a e.- BUILDING OR WORK 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SEPTIC TANK,SEEP,PIT(S)h AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY 'AND/OR DRAINFIELD WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT M THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AS E ESCRIBED TIAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE OF PERMITTEE BACKFILL SEPTIC TANKS ❑ SEEP.PITS) ❑ CESSPOOL! Q ALMATION ROBERT A. WOOD CK. M.O. CASH SUPERVISING MECHANICAL ENGINEER V' ,O 4 1 7 5 JAN 7 1 n D 7.(_-) 0