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HomeMy Public PortalAbout10607 FREER ST_Sewer__ + 76A64 2D 0-63 APPLICATION FOR PERMIT A64 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FNEARE �B YGa�r JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Supt of Building NEARE ��/ FADDRESSI OR APPLICANT TO FILL IN 7 AL ON LOT NO `0" OWNER �7 MAIL TRACT I�i` ADDRESS NO OF BLDGS OT NOW ON LOT L� CITY /��� �� a7pTEL. NO �c'GI9DISTRICT NO GROUP MAPPROCES DIBY /J� BK PG OR�.(,ir .����Y��/� C,Q/3Qom' ✓G ©g.�J CONNECTIONN DATA G6��I9C�JQ/G`i/ TTFL..pN NO � � STATION DEPTH REGISTRATION NO K�ti��/ �4e [:1 COUNTY MANHOLE 9--STATE I REFERENCE OWER NO DESCRIPTION OF WORK FEE YPE OF CONNECTION LENGT FROM HOUSE SEWER CONNECTING TO Y CURB P.L. M L T P,L PUBLIC SEWER @ S5 00 P C NO SEPTIC TANK,SEEPAGE PIT OR CO IMP NO JOB NO O PITS AND/OR DRAINFIELD @ S1000 V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO• ROAD PERMIT N f7 I= PRIVATE DISPOSAL SYSTEM @ $3 00 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER I EASEMENT RECORD.INSTR NO DATE 10 WORK TO HOUSE SEWER @ S3.00 U OVERFLOW SEEPAGE PIT.DRAINFIELD LU EXTN,CESSPOOL.DRYWELL,MANHOLE @ $500 ALTER.REPAIR OR ABANDON HOUSE HWY OR ST WIDENING N SEWER OR DISPOSAL SYSTEM @ $300 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNERS PERMIT s 2 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER f' j '� OWNERS AGENT L CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) IH ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS CESSPOOL ❑ DRYWELL ❑ IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABOV E�ED RES BE1MT,tAL PROPERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PERMITTEE SEEP,PITS) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M O CASH �titJv$ 0 3 8-0 JAPI 2 9 1 0 D 7.0 0-