HomeMy Public PortalAbout10671 FREER ST_Sewer__ DEPARTMENT OP COUNTY ENGINEER ! SEWER—SEWAGE DISPOSAL 1
DIVISION OF BitILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY EN13INEER i. BUILDING
ADDRESS (p
FOR APPLICANT TO FILL IN LOCALITY n`, , UC \ /
BUILDING��� � NEAREST.1���� CROSS ST ✓ `'
ADDRESS y7
LOCALITY
`��� � � DISTRICT NO. SERIAL NO. PERMIT NO.
V ! _ / /a
NEAREST /� /fes
CROSS ST. A S
� REC IVED Y Ready for Inspection DATE ISSUED
OWNER
MAIL,00' U8E ZONE OCCUPANCY BK MAP PG
AD-DRESS �o /
CITY TELAO.
CONTRACTOR ,California Sewer Const.ca_ CO.IMP.NO.
ADDRESS -' 11317 Ciolegrove Ave. JUB.NO.
CITY Montebello TEL.NO.UNlon 1-5048 TRUNK PERMIT NO.
E] TATE
REGISk�ATION N0. 3.04'445 SVagMNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. STATE ENCROACHMENT
PERMIT NO.
BLOCK 46TRACT //,,19,6 WADUSTRIAL
STE APPROVAL _
SIZE OF LOT NO.OF BLOGS. \
NOW ON LOT CHARGES
USE
BUILDINGS CONNECTION CHARGE FEE /
�,�� HAR
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.00 J510 RECEIPT NO. /I� ATE I BY
HOUSE SEWER CONNECTING TO
PR VATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BEDG.OR / EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 I N0.
ALTER OR REPAIR EXISTING DATE
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/ORDRAINFIELD 2.00 STATION DEPTH
DEPTH
CESSPOOL—DRYWELL MANHOLE REFERENCE
SPECIAL CONDITIONS ONLY 2.00 I Lf 3,3 I l/V fi-1 UPPERO;WB
TYPE OF CONNECTION-� LENGTH FROM
OWNERS PERMIT $ I 1 00 %Y °trete-�P-�-/ M.L.TO P.L. 1S
AUTHORIZATION I TOTAL FEE
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P_UJjBLIC SEWER - Q
SIGNED THIS-__,g_0____.___.DAY OF ._ a'�+-/ 19, NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL -
OWNERS AGENT. __ BUILDING OR WORK
J yy �- ��� SEPTIC TANK,SEEP.PIT(S)
ADDRESS t......... ....................................( AqD/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL E] DRYWELL E]CATIONAND 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 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 I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS r
SIGNATURE
SEEP.PIT(S)� CESSPOOLS SGk ynr_ 1.2�
.. ,�j�
OF PERMITTEE....f?� - - - .......- ___......
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