HomeMy Public PortalAbout10543 FREER ST_Sewer__ DEPAR•TNIDNT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 3I
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION 5
COUNTY OF LOS ANGELES -
WILLIAM J. FOX, COUNTY ENGINEER BUILDING /�5
.I ADDRESS ( U"
FOR APPLICANT TO FILL IN LOCALITY
BUILDING,.j p���� `[�����
ADDRESS U T CROSS ST.
LOCALITY � v _ DISTRICT N0. SE�iIAL NU. PERMIT NO. c
NEAREST ' S A /D O J
CROSS ST. RECEIVED BY Ready for Inspection DATE(ISSUED
OWNER
MAIL USE ZONE OCCUPANCY MAP
ADDRESS ,�f /y ��/(� I I BK PG
CITY TEL.NO. A -� I
CONTRACTOR California Sewer Const.Co Co.IMP.NO.
ADDRESS 1317 Colegrove Ave. JOB.NO.
CITY Montebello TEL.NO. UNlon 1-504E TRUNK PERMIT NO. --��-
REGISTRATION N0. 104445W1d.CltTY ROAD PERMIT N0.
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMENTPERMIT NO.
BLOCK TRACT/I�K Q INDUSTRIAL
WASTE APPROVAL
SIZE OF LOTS,Ox �.7� N0.OF SLOGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLICSEWER @ $ 3.50 RECEIPT NO. I _D'X.T.\ IBY
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 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR Q /
PITS AND/OR DRAINFIELD 2.00 STATION /O { (� ! DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 / p MANHOLE REFERENCE I/ -�J
LOWER
TYPE OF CONNECTION LENGTH FROM .f c
OWNERS PERMIT _ $ I 1 00 CbRa— ` 'y M.L.TO P.L. L�J
AUTHORIZATION I TOTAL FEE.
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P_U,3LIC SEWER /�,, ¢ l fI
.. O'C-t / 19_6.3 NEW,HOUSE SEWER
SIGNED THIS. L�.__.__.._DAY ________________________
OWNER OR - - CONNECT ADDITIONAL
OWNERS AGE BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS-.........- __...3
r \ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPL►- CESSPOOL E] DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALLIGOUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR.
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT IAM PROPERLY REGISTERED
AND/CR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS (
SIGNATURSEEP.PIT(S)E] CESSPOOLS
F PERMI
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