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Home My Public Portal About10659 FREER ST_Sewer__ e f 6A642 0-63" APPLICATION FOR PERMIT 76A642D40 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION FADORE JOHN A. LAMBIE, County Engineer WILLIAM A. JENSEN, Sup't of Building 5-C -AFOR APPLICANT TO FILL IN i ss LEGAL DESCRIPTION LOT NO / OWNERMAIL J7/�/ C..��• ��'� BLOCK TRACT ADDRESS 5;7, � /��4 [/ NO. OF SLOGS. SIZE OF LOT NOW ON LOT CITY / TEL. NO. IUSE OF BUILD DISTRICT NO. GROUP MAP F OCE D BY CONTRACTOR' �G/•GAO/I/C�/�"J C-�P !1Gi • %K._ -G 6 I ADDRESS 1,3Oe—o'o,Ci✓e Gv� CONNNECTION DATA CITY/4(" �� TEL NO �TL"✓'//% ATION DEPTH A STATE MANHOLE REFER NC UPP REGISTRATION NO. (0 �'rJy-�/` ❑ COU- NO. NO. DESCRIPTION OF WORK FEE TYPE ONNECTION LENGT OM HOUSE SEWER CONNECTING TO B P L.'" M L T .L. PUBLIC SEWER @ $5.00 P.C.NO. d SEPTIC TANK,SEEPAGE PIT OR CO.IMP NO JOB NO Q PITS AND/OR DRAINFIELD @ E10.00 V HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO PRIVATE DISPOSAL SYSTEM @ $300 CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVEREASEMENT RECORD. INSTR NO DATE O WORK TO HOUSE SEWER E3 00 U F�E OVRF ELOW SEEPAGE PIT,DRAINFIELD _ XTN,CESSPOOL,DRYWELL.MA NH OLE @ $5 00 yy li.l ALTER,REPAIR OR ABANDON HOUSE HW ST ID N SEWEROR DISPOSAL SYSTEM @ S3 00 STATE NCROACH MENT L PERMIT NO INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN AMED 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 CONNECT ADDITIONAL BUILDING OR WORK ADDRESS 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 ❑ I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSALSYSTEM CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE ABO ESCRIBED R IDENTI L PROPERTY. / .e// ABANDON HOUSE SEWER SIGNATURE i¢,/J / � L.�V� BACKFILL SEPTIC TANKS ❑ OF PERMITTEE �/�(� 7� SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M O CASH UiCo 5 7 3 5 NOV Q 1 0 D 7.0 0 L � r °r 6A642 0-63 • - APPLICATION FOR PERMIT 76A642D u COUNTY OF LOS ANGELES SEWER-SEW GE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS ENO. WILLIAM A. JENSEN, Sup't of Building AL LOCALITYNEAREST > FOR APPLICANT TO FILL IN CRD55 BTDESCRGPTION LOT NO OWNERBLOCK TRACT / MAILADDRESSNO OF BLDGS SITE OF LOT NOWON LOT CITY TE USE OF ��l J /� BUILDINGS i% Gf DISTRICT jjj]GRO�UUP MAP OCES BY �j� /�J /� •� BK PG r CONTRACTOR ADDRESS C014RECTION DATA CITY �/� Q`�r TEL NO �iyy /�JJION DEPTH .16 /sO // A STATE MANHOLE REFERS C®t' P REGISTRATION NO (Q 9`/•�• El COUNTY U[ NO DESCRIPTION OF WORK FEE TYP NECTION LENGTH F M HOUSE SEWER CONNECTING TO P L M L TO } PUBLIC SEWER @ $5 00 SEPTIC TANK,SEEPAGE PIT OR P C NO. O PITS AND/OR DRAINFIELD �° $10 00 CO IMP NO JOB NO. IL) /�� HOUSE SEWER CONNECTING TO TRUNK PERMIT NO ROAD PERMIT N( �� ex PRIVATE DISPOSAL SYSTEM @ 53 00 / `.`� ^ CONNECT ADDITIONAL BLDG OR AFFIDAVIT WAIVER EASEMENT RECORD INSTR NO DATE G WORK TO HOUSE SEWER @ $300 OVERFLOW SEEPAGE PIT,DRAINFIELD d7W EXTN,CESSPOOL,DRYWELL,MANHOLE @ $5.00 a ALTER.REPAIR OR ABANDON HOUSE HST WIDE I G Ali N SEWIER OR DISPOSAL SYSTEM @ $3.00 STA O CH ENT I PERMI NO INDUSTRIAL WASTE APPROVAL CHARGES ' OWNER'S PERMIT S AUTHORIZATION TOTAL FEE /�y� 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 S� NATURE SIGNED THIS DAY OF _19— OWNER 9_OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL- . ADDRESS BUILDING OR WORK SEPTIC TANK,SEEP,PIT(5) I HEREBY ACKNOWLEDGE THAT 1 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 ❑ I 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 ABOV ESCRIBED R E7QT.�AL PROPERTY, ABANDON HOUSE SEWER SIGNATURE c V/U r�� BACKFILL SEPTIC TANKS ❑ J OF PERMITTEE ///��,,, �` SEEP.PIT(S) ❑ CESSPOOLS ❑ ALIDATION ROBERT A. WOOD SUPERVISING MECHANICAL ENGINEER CK. M O CASH LiCo 5 7 361-0 NOV 9 1 1 D 2 5.0 0- v