HomeMy Public PortalAbout10732 FREER ST_Sewer__ DEPAUTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL- 1
' DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION ,
COUNTY OF LOS ANGELES
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING 10792
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ADDRESS ./ f� rFy���
FOR APPLICANT TO FILL IN LOCALITY
ADDRESS CROSS STNEAREST. zr/y� -4�I
LOCALITY DISTRICT NO. SERIAL NO. _53 3T—/
NO. C
NEAREST _ n , {iD A �Q/�Q/ �d�. 3MI/ S
CROSS ST.
RECEIV Ready for Inspection DATE ISSUED
OWNER % � 7
MAILfig US ZONE OCCUPANCY T MAP
ADDRESS dCJt BK PG
CITY TELAO.
CONTRACTOR CO.IMP.N0.
ADDRESS Q ,�
JOB N0.
CITY TELAO. ✓ ��
TRUNK PERMIT N0.
REGISTRATION NO. f��`�3 C." �� SAi1RTY
ROAD PERMIT NO.
LEGAL /
DESCRIPTION LOT NO. STATE ENCROACHMENT_
PERMIT NO.
BLOCK TRACT l 7INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT NO.OF BLDGS.
NOW ON LOT CHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE------ --
NO. DESCRIPTION OF WORK FEE
NOUSf SEWER CONNECTING TO REIMBURSEMENT FEES--' __.-• -
PUBLICSEWER @ $ 3.50 4 RECEIPT NO. ^-� DATE BY
HOUSE SEWER CONNECTING TO _
PRIVATE DISPOSAL SYSTEM 1.00 _
COF:HECT ADDI-T!OH L BL DS.Oft EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING ,OSI• UATe--- I_$Y _
SEWER OR DISPOSAL SYSTEM 1.00 4
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR _
PITS AND/OR DRAINFIELD 2.00 STATIONDEPTH .�
CESSPOOL—DRYWELL 4X71S�
SPECIAL CONDITIONS ONLY 2.00 'MA
REFERENCE
/ w, p UPPER — 0mL
YPE OF CONNECTION' LENGTH F
OWNERS PERMIT $ 1 00 CURB— P.L. M.1,,,
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 PUBLIC SEWER
SIGNED THIS.24 AY F--Max'C)1---------------•----19 55 NEW HOUSE SEWER
OWNER OR - CONNECT ADDITIONAL
OWNERS AGENT_ - _-__---- __--___ BUILDING OR WORK
ADDRESS 27 ►S. San-_-Gabriwl- Blvd. SEPTIC TANK,SEEP.PIT(S)
r - AND/OR DRAINFIELD
aTr-ua�i���.�oz rJr�—
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL� DRYWELL Ej
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 I AM PROPERLY REGISTERED AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT ABANDON HOPLUG PLUG AND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED R IDENTIAL PROPERTY.
BACKFILLSEPTIC TANKS
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SIGNATURE .� �- ... SEEP.PIT(S)� CESSPOOLS
OF PERMITTEE__ _ __,:/�/-_
76A642D 663 1/53