HomeMy Public PortalAbout10629 FREER ST_Sewer__ DEPAItrMETF T OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY 0&� PERMIT APPLICATION, 9 1
COUNTY OF LOS ANGELES
l06%2WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
ADDRESS
-FOR APPLICA T TO FILL IN LOCALITY
BUILDINGNEAREST
ADDRESS ��Q/7 CROSS ST.
LOCALITY
DISTRICT NO. SERIAL NO. PERMIT NO.
p w -
CROSNEAREST A �� Q S
�RECEIVED BY Ready for Inspection DATE/ISSUED
OWNER
MAIL OCCUPANCY MAP
ADDRESS V� /)/I/LD, USEZONE - ( BK PG
CITY TEL.NO. ; A - 1 J/e�
t
CONT"-pOR
,_ California S'g1A®IGenSt.-Co CO.IMP.NO.
ADDRESS `'11317 ColAn'rnVg Ave. JOB NO.
CITY Alontebello TEL.NO. r TRUNK PERMIT NO.
TSTA�
REGISk..BATION NO. 10444,C"j COUNTY ROAD PERMIT NO.
LEGW Q�
DESCRIPTION LOT NO. / / STATE ENCROACHMENT
/ PERMIT NO.
BLOCK TRACT /���� INDUSTRIAL
rr/666 WASTE APPROVAL
SIZE OF LOT �/ NO.OF SLOGS. 11
R /�r�Ufl NOW ON LOT l CHARGES
USE OF �1
BUILDINGS �Q�/ CONNECTION CHARGE FEE
N0. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO ���
PUBLICSEWER @ S 3.50 RECEIPT NO. / DA?EBY
HOUSE SEWER CONNECTING TO \
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDJTIONAL BLDG.OR / EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
— ALTER OR REPAIR EXISTING / NO- DATE BY\
SEWER OR DISPOSAL SYSTEM _ 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/0R DRAINFIELD 2.00 CESSPOOL—DRYWELL STATION 4-3 2 O DEPTH {
1
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE 'A, _ LOWER
VV
TYPE OF CONNECTION LENGTH FROM
+- BkFRB�
OWNERS � ! PERMIT $ I 00 M.L.TO P.L.
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED;
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING
DWELLING TO THE APPROVALS INSPECTOR'S SIGNATURE DATE
P t3LIC SEWER 0'��
�SIGNED THIS.._. DAY OF....... .19_�!_J NEW HOUSESEWER
OWNER OR - _ CONNECT ADDITIONAL
OWNERS AGE T. ... BUILDING OR WORK
------••-................
f� SEPTIC TANK,SEEP.PIT(S) ,
ADDRESS.................�y_ ..7-. ..........-....
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 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
1 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 1 AM THE LEGAL OWN.
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS E]
SIGNATURE ��J- , SEEP.PIT(S)� CESSPOOLS
OF PERMITTEE..-=— :' ._.._... - -...-._..... --
76A642D 663 1/53