HomeMy Public PortalAbout10667 FREER ST_Sewer__ 76A842D APPLICATION FOR �ERMIT' - _
ceeoe-a-se COUNTY OF LOS ANGELES, •
. .' SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNLDIVISION
EER
BUILDING AND SAFETBUILDING
ADDRESS'
JOHN A. LAMBIE, CounCASSATT D. GRIFFIN, Supg LOCALITY C
NEAREST
FOR APPLICANT TO FILL' IN CROSS ST. 91 d8pt a Aze_
LEGAL
DESCRIPTION ` LOT N0. 12 OWNER Cheroske
BMAIL
LOCK A,. TRACT 112 90 ADDRESS
—�1LN: Ramnnri
NO.OF BLDGS. _
SIZE OF LOT. NOW ON LOT 3 CIT TEL. NO.
USE OF
BUILDINGS Res e _ - DISTRICT NO. GROUP -MAP, ' s PROCESSED BY*
m//�� BK PG
CONTRACTOR' Square Deal Sewer- Service !V ,
ADDRESS 2 Max, On Rd. , - ___ CONNECTION DATA
CITY El Monte} TEL.NO. GI 4-2020 STATION 1 �„�) `�•�-G!�DEPTH
REGISTRATION NO. 120870 ®' STATE MANHO / FERENCE 3 UPPER'_
COUNTY "�� --
NO. DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO
l PUBLIC SEWER @ $8.00 00
SEPTIC TANK, SEEPAGE PIT OR TYPE OF CONNECTION ENGTH FROM
ITS AND/OR DRAINFIELD @ $8.00 Y. CURB P.L. M.L.-TO P.L. '-
OVERFLOW SEEPAGE PIT, DRAINFIELD '
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00'
P.C.NO
HOUSE SEWER CONNECTING TO ,--
PRIVATE DISPOSAL SYSTEM �'$1.00 - CO. M .NO. JOB N0.
-CONNECT ADDITIONAL BLDG.OR,- TRUNK PERMIT N0. ROAD PERMIT N0, ,(�
WORK TO HOUSE SEWER Q $1.00 %�-� a
ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM Q $1A0'. PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNERlS. PERMIT 5 11 2- 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE -
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING e
TO THE PUBLIC SEWER. / M
SIGNED THIS _ SAY OF 19— NEW HOUSE SEWER • y �
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT � j�T BUILDING,OR WORK
ADDRESS '4 SEPTIC-TANK,SEEP,PIT(S) -
AND/OR DRAINFIELD.
I HEREBY ACKNOWLEDGE THAT I HAVE*READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO'COMPLY CESSPOOL❑ DRYWELL'❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,-SEWER OR
PLUMBING AND SEWERS. I I SEWAGE.DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR G AN
LICENSED AS REQUIRED BY LOS ANGELES COUNTY A DISCONNECT PLUG D
D STATE OF ABANDON CT PLUSEW D
CALIFORNIA OR THAT I AM THE LEGAL'OWNER, THE ABOVE
DESCRIBED. RESIDENTIAL PROP RTY BACKFILL SEPTIC TANKS❑
SIGNATURE _ - SEP. PIT(S) .CESSPOOLS❑ -
OF PERMIT TE - - -
®. ATION- =ROBERT A.WOOD
y Q� mag SUPERVISING MECHANICAL ENGINEER
jv .E.. 1. J- rJ yr^t t^
n'
CES08-D APPLICATION FOR P � RMIT."-
ceaoa-e•sa COUNTY OF LOS ANGELES .1.-
.•SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
ADDRESS I
JOHN A. LAMBIE, County Engines
CASSATT D. GRIFFIN, Sup't of Building LOCALITY
NEAREST
FOR APPLICANT TO FILL IN CROSS ST. r,� D&Qnt a A va_
LEGAL
DESCRIPTION LOT NO. 1 OWNER ChAi^n�A
BLOCK MAIL
.A TRACT 112 0 ADDRESS 30 No Raymond
NO.OF BLDGS. D _ -
SIZE OF LOT NOW ON LOT CITY Pasadena TEL.'NO..
USE OF
BUILDINGS Res• - DISTRICT NO. GRA BK MAP PG PROCESSED BY
CONTRACTORSquare Deal Sewer Service iiJ
J+.UcJ
ADDRES2 Mwcson Rd. CONNECTION DATA
CITY 1 Monte' TEL.N0. GI 2020 STATIO ��'PEPTH
�} STATE MANHOL� fEFERENCE UPS
REGISTRATION N0, 12$$ O B COUNTY +
No. DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO
PUBLIC SEWER 0 $8.00 TYPE OF CONNECTION LENGTH FROM ) �
SEPTIC TANK,SEEPAGE PIT OR Y. CURB M.L.TO P.L. X J+
PITS AND/OR DRAINFIELD Q $9.00
OVERFLOW SEEPAGE PIT, DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE 0 $2.00
HOUSE SEWER CONNECTING TO P.C.NO.
PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.N0: JOB NO. -
CONNECT ADDITIONAL BLDG.OR TRUNK PERMIT NO. = ROAD PERMIT N
WORK TO HOUSE SEWER @ $1.00" O.
ALTER, REPAIR OR ABANDON HOUSE STATE ENCROACHMENT
SEWER OR DISPOSAL SYSTEM Q $1.00• PERMIT NO.,
1 Saddle 25 OO INDUSTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PEST $ CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 1 25 100 REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN-NAMED CON. APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE-PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR *
CONNECT•ADDITIONAL'
OWNERS AGENT BUILDING OR WORK
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
AHEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT-PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER-OF HE A VE
DESCRIBED RESIDENTI&L PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE T
SEEP.PIS ❑ CESSPOOLS❑
OF PERMIT EF
®r ALMATION ROBERT A.WOOD
Bd g,p� QAatt SUPERVISING MECHANICAL ENGINEER
— C+
14