HomeMy Public PortalAbout10708 FREER ST_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE' DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT-APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER •BUILDING
I ADDRESS
FOR APPLICANT TO FILL IN LOCALITY � �� �
BUILDING NEAREST
ADDRESS 107CR F1'AAT Vit. CROSS ST_
LOCALITY El Monte DISTRICT NO. SERIAL NO. PERMIT NO.
NEAREST .S=CG A � d 5� S-���-✓f"�-�
CROSS ST. Trinv,ta
��.-��.BVP' RECEIVED BY Ready for Inspection DATE ISSUED
OWNER P. L• MCNntt �i�� �"— ye-/- ::�v
MAIL 1 USE ZONE OCCUPANCY MAP
ADDRESS `27'2-k San Gabriel Blvd, BK PG
CITY San Gabriel TEL.No. AT 94364 ---
CONTRACTOR LaDj & M. COnstruCtion CO. CO.IMP.NO.
ADDRESS AOA Winthrop I?r. JOB NO.
CITY Alhambra TEL.No. AT 48315
TRUNK PERMIT N0.
STATE
REGISTRATION
REGISTRATION NO. 113613-0-42 COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. 1j PERMIT NO. -,
BLOCK TRACT 17867 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLOGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS 1 Res* CONNECTION CHARGE EE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE
1 PUBLICSEWER @ $ 3.50 0 RECEIPT NO. �- DA�'IEI BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT-ADDITIONAL BLDG.OR i EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO- 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
PITS AND/OR DRAINFIELD 2.00 STATION Z DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MA OLE REFERENCE
�f Q PPER
TYPE OF CONNECT ON LENGTH FROM
OWNERS PERMIT $ 1 00 CURB— P.L. M.L.TO P.L.
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
i
SIGNED THIS--------------------DAY OF..........................._...........19i NEW HOUSE SEWER
OWNER OR t CONNECT ADDITIONAL
OWNERS AGENT...................-.................................................. BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS_________________________
---------•_________________________•------------•-----------•---•• AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL Ej DRYWELL E]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
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 1 AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL
PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE
E��iG^' !L l�C//_G1 0111'LGG]l� ..--- SEEP.PIT(S)� CESSPOOLS
OF PERMITTE
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