HomeMy Public PortalAbout10662 FREER ST_Sewer__ DEPARTMENT OF COUNTY ENGEVEER SEWER—SEWAGE DISPOSAL
10291
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING /
ADDRESS Q (p
FOR APPLICANT TO FILL IN LOCALITY ,(
BUILDINGIZ) / a e CNEAREST
ROSS ST. /
ADDRESS fJf
LOCALITY �j �n DISTRICT NO. SERIAL NO. PERMIT.NO.
NEAREST " /Y( � i A Lf / / L S
CROSS ST. ��< �" /
J 6RE IVED BY Ready for Inspection / DATE ISSUED
0 W N E R�y (✓. ► ` I � /� 1) ( �' `�
i
MAIL USE ZONE OCCUPANCY MAP
ADDRESS I I BK PG m�
CITY TEL.NO.
CONTRACTOR California Sewer Const,,oo s CO.IMP.N0.
ADDRESS 1317 Colegroye Ave. X06.No.
CITY Montebello TEL-NO.UNion 15048 TRUNK PERMIT NO.
TATE
' REGISTRATION N0. 104445 S "TY ROAD PERMIT N0.
DESCRIPTION LOT NO. STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT/ D� INDUSTRIAL
WASTE APPROVAL p
SIZE OF.LOT�] //'' y NO.OF BLDGS.
/�7 �� NOW ON LOT k CHARGES
BUILDINGS OF CONNEC IT ON�CHARGE FEE
NO. DESG IPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
/ PUBLICSEWER @ S 3.50 D RECEIPT NO. DATE BY
—T' HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR '1� EXCEPTION RECORDED
WORK TO HOUSE SEWER - 1.00
ALTER OR REPAIR EXISTING NO- I DATE �I BY
SEWER OR DISPOSAL_SYSTEM 1.00 '�
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR /y
PITS AND/OR DRAINFIELD 2.00 STATION 1��,�_ DEPTH J%
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 ` NHOLE REFERENCE
D7VUPPERII3SClcR
TYPE OF CONNE TION_, LENGTH FROM
OWNERS PERMIT I 00 A4— CtHm M.L.
TO P.L.
0
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE' PLIC SEWER
� /
SIGNED THIS._.36._ DAY OF------- _.4 _x
NEW HOUSE SEWER 5'G ~0 G O �� .
�,w .� CONNECT ADDITIONAL
OWNER OR !'V"� � BUILDING OR WORK
OWNERSAGEN//T ----------`•--- �--,/--...�--- --••------•--•-- --..._._.....----
ADDRESS./D,Ip_&�.:._. ` SEPTIC TANK,SEEP.PITS),
�" "�..-2'!^-=----------------------.---. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL
CA
TIONAND 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 REGISTER..
R DISCONNECT PLUG AND
AND/OLICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RE IDENTIAL PROPERTY BACKFILL SEPTIC TANKS❑ J
SIGNATURE SEEP.PIT(S)[D CESSPOOLS f1Cr/I jock
a sC
OF PERMITTEE F ;— - — .9.
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