HomeMy Public PortalAbout10604 FREER ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-i—SEWAGE' DISPOSAL 9,521
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENsINEERBUILDING /y
ADDRESS f/o
LOCALITY
FOR APPLICANT TO FILL IN 6 _
`• ~BUILDING �y NEAREST r
ADDRESS//6 D 41 CROSS ST.,
LOCALITY ��%��
DISTRICT N0. SERIAL N0. PERMIT
ANO.
NEAREST
CROSS ST.
,,�IY)){/✓� I ; R�E>CEIV.,E�D,By p' Ready for Inapeetlon [DATE I SUED
OWNER ,
MAIL ^ /
ADDRESS USE ZONE ( 0 CUPANCY BK MAP PG
- /� V�/'��� -)
.-CITY ' TELAO. A—
CONTRACTORCallf ornia Sewer CoriSt•Co. I CO.IMP.NO. G,L�����g___+++
ADDRESS 1317 Colegroye Ave. JOB.NO.
CITY Montebello TEL.NdjNlon 15048
TRUNK PERMIT NO.ATE
�
REGISTRATION NO.10444/5 St�t TUNNTN
TY ROAD PERMIT NO.LEGL
DESCRIPTION LOT NO. / , OG 3 A3 /3 /, STATE ENCROACHMENT
PERMIT O.
BLOCK F/ TRACT /!,�i?D WASTE APPROVAL �-
SIZE OF LOT S6_DSx,gI 6aN0&W ON LOTS CHARGES
:.�
USE OF
BUI DINGS fie( CONNECT!GN CHARGE•XEE
NO. DESCRIPTION OF WORK FEE `f T�s�
HOUSE SEWER CONNECTING TO = 1 R IMBURSEMENT FEE. ��
PUBLICSEWER @ $ 3.50 u, DATE BY
_ `, RECEIPT N0 �' �
HOUSE SEWER CONNECTING TO 4 q
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR
WORK C HOUSE SEWER 1.00 '-,` G7 EXCEPTION RECORDE
ALTER OR REPAIR-EXISTING pyx
NO. I DATE I B
SEWER OR_DISPOSAL SYSTEM 1.00 r„ +
il
DISCONNECT AND ABANDON SEWER + x -u
AND/OR DISPOSAL SYSTEM . 1.00_ :. ti CONNECTION DATA
SEPTIC TANK,SEEPAGE
_ PTS AND/OR DRAINFIELD T OR 2 00STATION �O {. �� O DEPTH /
CESSPOOL—DRYWELL �!
SPECIAL CONDITIONS ONLY 2.00 f y MANHOOLLE REFERENCE . LOWER
TYPE OF CONNECTIO LENGTH FWRQM
OWNERS _PERMIT ; I 1 00 r�iRu pirLr " M.L.TO P.L. y
AUTHORIZATION [ TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMEDf
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING; APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
' J
SIGNED THIS... 0.z5e f NEW HOUSE SEWER _ f /
D Y O®F _.....19. ,�i G01 y O c-
.
OWNER -OR OL> �� q w-
TT �' IONNECT'ADDtTION
BUILDiNG_OR WORK._ ,
0 W N ERS ALGE�/N -/---------/-------/-�-----�-------- ---••--- --------7---•---- -
ADDRESS..'!'-/.Q.ED.QY-=-.lr�._r. SEPTIC TANK;SEEP.Pit-'(S)
/�./.1,.F-..F�.�'Z,--.-._.__..1...���.. AND/OR DRAINFIELD -
f HEREBY ACKNOWLEDGE THAT.I HAVE READ THIS APPLI- ' CESSPOOL E] DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
ALTER,REPAIR.SEWER OR
TO CAM PLY WITH ALL COUNTY ORDINANCES AND STATE LAWS
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL_SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND
ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-'
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
' SIGNATURE / i(/1 SEEP.PIT(S)� CESSPOOLS
�( r.! . -
OF PERMITTEE- ._�._
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