HomeMy Public PortalAbout10670 FREER ST_Sewer__ D
S&'E-683 11.53 APPLICATION FOR PERMIT 1
S&'6.8
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Department of County Engineer
.County of Los Angeles TfADDRESS
gyp(, O
_JOHN A. LAMBIE. COUNTY ENGINEER® CASSATT D. GRIFFIN, SUPT OF BUILDING•
NEAREST
FOR APPLICANT TO FILL IN CROSS ST, Q� '
LEGAL OWNER
—DES'CRIPTION LOT NO. MAIL _
BLOCK TRACT r AD DRESS �a OLTB� JJ
NO. OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT _
USE OF DISTRICT, NO. GROUP MAP
BUILDINGS ! I P�
CONTRACTOR
/ CONNECTION DATA
ADDRESS X4617
LDn_ o_ `/ 7 STATION DEPTH
CITY TEL. N0. [�/tT U �- UPPER
MANHOLE REFERENCE _
STATE LOWER
REGISTRATION N0, l
6 .
REGISTRATION ❑ COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L. TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD. P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM @. $1 00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ $1 00 PERMIT NO.
ALTER,REV*IR OR eAUZI&N HOUSE INDUSTRIAL
SEWER SYSTEM @ $1.00 WASTE APPROVAL
a
Z_t
4L:.i CHARGES
1 CONNECTION CHARGE FEE,
OWNER'S PERMIT ' $ 00
REIMBURSEMENT FEE
AUTI40RIZATION TOTAL FEE ,3 140 o
1 HAVE AT THIS DATE A.CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER -
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT ' SEPTIC TANK,SEEP, PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY -
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR / F;
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM l�
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AN
LICENSED AS REOUIRED BY LOS ANGELES COUNTY AND STATE OF D
ABANDON HOUSE SEW D
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
ER
DESCRIBED RESIDENTIAL
PROPERTY. �yBACKFILL SEPTIC TANKS❑
SIGNATURE ./7 1 -/� SEEP PIT(5) ❑ CESSPOOLS❑
OF PERMITTEE Yaab V
JOHN A. LAMBIE, COUNTY ENGINEER �LIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
EI 0. CASH
! �a 7
T2 7 MAR 15 1 U' A 3.00 - A
r DEPART INT OF COUNTY ENGINEER SEWER—SEWAGE DISPOSAL 10 3 d
DIVISIQN OF BUILDING AND SAFETY PERMIT APPLICATION
v COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER BUILDING / �/ z[ p��
I ADDRESS /O
FBUILDINGOR APPLICANT TOA FILL:'`IN� � p � LOCALITY
ADDRESS /(J /!J —(�� ',Li�/�•I NEAREST
' CROSS ST.
,LOCALITY�=�.��� r f ' DISTRICT NO. SERIAL NO. PERMIT NO.
TNEAREST
CROSS ST. I! ;y�','�;
n f �/ �� (RECEIVED BY Ready for Inspection DATE/(ISSUED
OWNERP,Q I /)tA NNA"JIC'� I ( /1—t7 - 6-z
MAIL ADDRESS ,�/�/)/J/�,Q I USE ZONE OCCUPANCY MAP
BK PG
- CITY TEL.NO.
CONTRACTOR California Sewer Const_CQ ! CO.IMP.NO. C4 9
ADDRESS 1317 Colegrove Ave JOB.NO.
CITY Montebello TEL.NO.UNion 1-50&& TRUNK PERMIT NO. C_
STATE
/REGISTRATION NO. 104445 s&t"NTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMENT
3 PERMIT NO.
ASTBLOCK TRACT �gs INDUS APPROVAL
z, `
SIZE OF LOT 7J A/ /:3 b N0.OF BLDGS. ,
NOW ON LOT L CHARGES
USE
BUILDINGS CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEME41►T.FEE �y s
I PUBLIC SEWER $ 3.50 RECEIPT NO. _,`-DATE I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION R RDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- I DATE BY
SEWER OR DISPOSAL SYSTEM f.OD
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 I CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION 3+ 3, S DEPTH g
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 OANHOLE
UPPER REFERENCE COMM
TYPE OF CONN CTIO LENGTHTROM
OWNERS PERMIT $ 1 OtH B P.L. M.L.TO P.L.
I 00
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 PUBLIC SEWER/�
SIGNED THIS...J .
. .DAY OF �t .....19S NEW HOUSE SEWER t ®a �►
OWNER ORG 7 /� `v CONNECT ADDITIONAL
.OWNERS AGEN K-� ------------ BUILDING R WORK
SEPTIC
A /L.rirL: ............._... AND/OR DRAINFIELD PIT(S)
I ADDRESS.
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL C]
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
I HEREBY CERTIFY THAT 1 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 R IDENTIAL PROPERTY. BACKFILLSEPTIC.TANKS�
SIGNATURE �f SEEP.PIT(3)� CESSPOOLS
SOF-'OF f
x w •,
,Gd642D G63 1/53