HomeMy Public PortalAbout10603 FREER ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL- -9 5 Q 1
DIVISION OF BUILDING AND SAFETY t PERMIT APPLICATION
! COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING 3
I ADDRESS/Q 6 O
FOR APPLICANT TO FILL IN LOCALITYctil/OXO
BUILDING/J`/ /� 2` ��� NEAREST fl
ADDRESS ((�J(�Q (JJ � CROSS ST.
LOCALITY D:, ��
DISTRICT NO. StAIAL NO. PERMIT NO.
NEAREST ~p Q J
CROSS ST. /Y,4�1 �_/� � � /" /� J
/ J� R�EC/FINED Y Ready for Inspection•, DATE/ISSUED.a�
OWNER �1!!�/
MAIL
ADDRESS �( �}/yt,.Q USE ZONE ' I 0NCY MAP
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CITY TEL.NO. ,
CONTRACTOR California Sewer Const.Co. Co.IMP,NO. Lx 9
ADDRESS 1317 Colegrove Ave. JOB NO. \_
CITY Montebello •TEL.NO.UNlon 1-5048 TRUNK PERMIT N0.
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REGISTRATION NO. �'04'�4'� NTY ROAD PERMIT'NO.'
LEGAL // STATE ENCROACHMENT
DESCRIPTION LOT N0. _JID PERMIT NO.
BLOCK
TRACT,/ L WADUSTRIAL
STE APPROVAL
SIZE OF LOT F BLDG .
D K� NOW ON LOTS CHARGES
USE OF
BUILDINGS �� CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE r O
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
PUBLIC SEWER @ $ 3.50 RECEIPT NO. I DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR 'EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 N0. DATE 8Y
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.001 ,
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAIN_FIELD 2.00 STATION '/0-0L j G d DEPTH /
CESSPOOLO CONDITIONS ONLY 2.00 DRYWELL
SPECIAL CO / Q / MANHOLE REFERENCE NLOWER
TYPE OF
-�` CONNECTI( L LENGTH FR
O
OWNERS PERMIT I oo ZVjrBN . M.L.TO P.L. M
-
AUTHORIZATION TOTAL FEE _ �Y-17�
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CO , APPROVALS INSPECTOR'S SIGNATURE DATE
CONTRACTOR TO CONNECT THE
G
E ABOVE DESCRIBED EXISTING
DWELLING TO THE PUULIC SEWER
SIGNED THIS_.-------- ___ DAY OF.. �._Ig r NEW HOUSE SEWER n-a �, /"ly "
A__.___r_______________
OWNER OR 1ILD NG OR WORK CO
QWNERS AGE = vl ...f!.. ..._ �. "!% U
SEPTIC TANK,SEEP.PIT(S)
ADDRESS 1s!.. _r____._ ___ .__/� �_.+-_ rte.._�.. _ AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I 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
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE /`)P ' ', SEEP.PIT(S) CESSPOOLS ,
OF PERMITTEE- _ _-- - f
--..____ .._�.....-- _ ----•---- '.�
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