HomeMy Public PortalAbout10714 FREER ST_Sewer__ IDEPA:]V MENT OF COUNTY ENGINEER SEWER-SEWAGE WSPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
-COUNTY OF LOS ANGELES
r WILLIAM J. FOX, COUNTY ENGINEER NG ADDRESS
FOR
FOR APPLICANT TO FILL IN LOCALITYBUILDING
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ADDRESS 10714 Freer St• NEAREST /
CROSS ST.
LOCALITYDISTRICT NO. I SERIAL NO. PERMIT NO.
NEAREST F.1 Monte
CROSS ST. El b'iOrit@ gve• Jr-1�O A � �•��5� J
RECEIVED
BY Ready for Inspection DATE ISSUED
OWNER PaL• McNuttMAIL
ADDRESS 272- Sall Gabriel Blvd. USEZONE OCCUPANCY MAP
BK PG
clry San Gabriel TEL.NO. - AT 94364G,S
CONTRACTORL• D. & M. Construntion Ono
CO.COIMP.N0.
ADDRESS 408 G tnthro= Dr. JOB No. —�
CITY Alh=bra TEL.NO. AT 483155 TRUNK PERMIT N0.
[�}} STATE
REGISTRATION NO. 113613-C-42 p COUNTY ROAD PERMIT NO.
LEGAL
DESCRIPTION LOT N0. 4 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT 17867 INDUSTRIAL _
WASTE APPROVAL
SIZE OF LOT N0.OF BL
NOW ON LOT
2 .y CHARGES
USOF
BUE DINGS 1 BeS• CONNECTION CHARGE FEE Ar
NO. DESCRIPTION OF WORK FEE _ e
HOUSE SEWER CONNECTING TO REIMBURSEMENT FEE �a
PUBLICSEWER @ $ 3.50 1 J•d RECEIPT NO. DhTE_--,,'_j BY
HOUSE SEWER CONNECTING TO I• /' I_
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00 NO,
ALTER OR REPAIR EXISTING DATE - BY
I I -
SEWEP.CR 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 2lI_ZZ DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00 O ANHOLE REFERENCE
- dt UPPER - 'aWF.R_
TYPE OF CON ECTIONLENGTH FROM
OWNERS PERMIT $ 1 00 -ewb& P.L.____ M.L.TO P.L.
AUTHORIZATION I TOTAL FEE 4�/ C)
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-------_---.-------DAY OF.......-............................._19------- NEW HOUSE SEWER < �I�-' ���o i
OWNER OR 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 E] DRYWELL F]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
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND
DISCONNECT ABANDON HOPLUG PLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S) CESSPOOLS
SIGNATURE
OF PERMITTEE _ ..........................
76A642D 663 1/53