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Home My Public Portal About10545 FREER ST_Sewer__ C866APPLICATION FOR PERMIT 76A642D u COUNTY OF LOS.ANGELES SEWER SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILLI ! - CROSS 6T LEGAL �� .DE:C•R IPf ION LOT NO OWNER MAIL BLOCK TRACT ADDRESS NO OF BLDGS /n SIZE OF LOT NOW ON LOT CITY ! TEL NO. USE OF DISTRICT NO, GROUP MAP PROLE O BY BUILDINGS r BK PG /r CONTRACTOR slog log _'t: ,� ,2 ADDRESS - CO ECTION ATA W CITY EL NO LI TION DEPTH 7 3 � AE STATE MANHOLE REFRENCE PPE REGISTRATION NO .� 0 ❑ COUNTY NO DESCRIPTION OF WORK FEE TYPE OF CONNE ION LENG FROM / HOUSE SEWER CONNECTING,TO ��I ,.apt Y CURB P.L. M L FF L. PUBLIC SEWER $5.00 25 V V / P C NO SEPTIC TANK,SEEPAGE PIT OR JOB NO. d PITS AND/OR DRAINFIELD @ 610 00 CO.IMP NO. O HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT NO. I---- P RIVATE ----PRIVATE DISPOSAL SYSTEM @ $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO. DATE WORK TO HOUSE SEWER @ S3 00 O OVERFLOW SEEPAGE PIT,DRAINFIELD V EXTN,CESSPOOL,DRYWELL,MA NH OLE @ SS 00 YA ALTER,REPAIR OR ABANDON HOUSE HWY OR ST.WIDENING h SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO INDUSTRIAL WASTE APPROVAL ' OWNERS PERMIT S z 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE 1HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEW / DATE INSPECTOR'S SIGNATURE SIGNED THIS / Y OF 195 1 i OWNER OR f L� NEW HOUSE SEWER B:�f�, F;a ♦ �-� OWNERS AGENT P CONNECT ADDITIONAL 1 BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) , I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI ATION AND/OR DRAT NFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY 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 I AM THE LEGAL O NER OF, AND NTEND TO DISCONNECT PLUG AND RESIDE IN, THEAB S IBED D IAL PRO TY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE ❑ SEEP.PIT(S) ❑ CESSPOOLS i VALIDATION ROBERT A. WOOD K. M Q CASH SUPERVISING MECHANICAL ENGINEER To 0- 4YI `��7��-ter✓ r LA 6A642 LO-63 APPLICATION FOR PERMIT 76A64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS O WILLIAM A. JENSEN, SY; f )ldin GEl' I / LOCALiTY NEAREST FOR APPLICANT O FILL IN CROSS BT LEGAL ` DESCRIPTION ' LOT NO /J OWNER �j MAIL % BLOCK .�' TRACT �/�. ` 0 ADDRESS NO OF BLDGS SIZE OF LOT NOW ON LOT CITY TEL NO USE OF BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY BK PG / . CONTRACTOR ` D /(j a 7 LA//IS ADDRESS �,J CCCJJJ CONNECTION/ DATA CITY TEL NO STATION 41/EPTH /D / REGISTRATION NOC� 4 'MJ TATE MANHOLE REFERENCE COUNTY OWER NO. DESCRIPTION OF WORK FEE TY OFC N N LENGT ROM HOUSE SEWER CONNECTING TO Y U P.L. M L TO P L } PUBLIC SEWER @ 55 00 9L SEPTIC TANK,SEEPAGE PIT OR P.0 NO. O PITS ANOR DRAINFIELD @ 31000 CO.IMP NO, JOB NO. V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 O CONNECT ADDITIONAL BLDG OR AFFIDAVIT I wAIVER EASEMENT RECORD INSTR NO, DATE WORK TO HOUSE SEWER @ S300 OVERFLOW SEEPAGE PIT,DRAINFIELD W EXTN,CESSPOOL.DRYWELL.MA NH OLE @ $500 ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST WIDENING h SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PER NO 4 41 INDUSTRI W AS CHARGES OWNERS PERMIT $ z 00 CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE. SIGNED THIS_�DAY OF 19 OWNER OR / /� �� NEW HOUSE SEWER OWNERS AGENT ✓ /• 4� R/�/Y� '�C.�_ CONNECT ADDITIONAL (i d ADDRESS _ BUILDING OR WORK SEPTIC TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ 1 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 I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESIDENTIAL PRO ERT ABANDON HOUSE SEWER K SIGNATURE " BACFILL SEPTIC TANKS ❑ OF PERMITTEE�J SEEP.PITS) ElCESSPOOLS /1 VALIDATION ROBERT A. WOOD CK m o CASH SUPERVISING MECHANICAL ENGINEER 6 9 4 6- NOV 1 1 0 D 7.0 0 6A64z�i.),U-63 76A64APPLICATION FOR PERMI !1 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER •BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS of WILLIAMM A. JEN EN. Su�'t Building Lo I LOCALITY r NEAREST zj FOR APPLICANT TO FILL IN `ROSS ST LEGAL DESCRIPTION LOT NO J OWNER _ BLOCK ,i TRACT / 2 Q ADDRESS MAIL V /V NO OF SLOGS SIZE OF LOT NOW ON LOT zrx z - CITY G TEL. NO. USE OF DISTRICT NO GROUP MAP PR CESSED BY BUILDINGS �.. }F1 0 � / BK, / PG CONTRACTOR ,� ge _Q J V o l N 2- ADDRESS CONNECTION DATA CITY TEL. NO STATION [IPTH ///Q / STATE e REGISTRATION NO Gi ❑ COUNTY MANHOLE REFERENCE / aj LOWE NO DESCRIPTION F ORK FEE TYPEIfCON EC I LENGTH F#iOM / HOUSE SEWER CONNECTING TO Y P.L. M L TO P.L PUBLIC SEWER @ $5.00 P.0 NO. SEPTIC TANK,SEEPAGE PIT OR JOB NO. O PITS AND/OR DRAINFIELD @ $1000 CO IMP NO V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT N PRIVATE DISPOSAL SYSTEM @ $3 00 2 cm CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE O WORK TO HOUSE SEWER @ S3.00 h OVERFLOW SEEPAGE PIT,DRAINFIELD W EXTN,CESSPOOL,DRYWELL.MANHOLE @ $5.00 ALTER,REPAIR OR ABANDON HOUSE HWY OR ST.WIDENING h SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT Z PERMIT NO INDUSTRL WASTE IA CHARGES OWNERS PERMIT s CONNECTION CHARGE FEE AUTHORIZATION TOTAL FEE 'IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF �7/1�-�9J 19 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ' ADDRESS " SEPTIC TANK.SEEP,PIT(S) XN IH ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD /'�� ._vf✓) AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ Jr 1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR n �� LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL S YSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOVE DESCRIBED RESID L PROP RTY. ABANDON HOUSE SEWER J':�-F NATURE iy BACKFILL SEPTIC TANKS ❑ PERMITTEE ❑, SEEP.PITS) ❑ CESSPOOLS s/ ALIDATION ROBERToA` wooer cK. M o CASH SUPERVISING MECHANICAL ENGINEER LAGO 6 9 4 7 NOV 1 1 1 D 2 5.0 0 N