HomeMy Public PortalAbout10783 FREER ST_Sewer__ C'
AEPARTMENT O, ENGINEER
�'®('�Y SEWER-SEWAGE DISPOSAL
DIVISION OF BU AND SAFETY PERMIT APPLICATION
COUNTY OF LOS GELES BUILDING •� p�
WILLIAM J. FOX, COUNTY ENGINEER I ADDRESS
FOR APPLICANT TO FILL IN LOCALITY ��
Q
BUILDING NEAREST
ADDRESS I �2 CROSS ST.
DISTRICT NO. SERIAL NO. PERMIT NO.
LOCALITY �L+IM,{�L�E � �T'y �- A � 7'"( 7 D�
NEAREST ,{,� G, �/� b ,,�
CROSS Si �V/ , ( I �.,r
1 �/� t w R EI ED BY Ready for Inspection DATEISSUED
OWNER l`ewpjggw Mr-AJA04v4!R,4 / Jed r
ADDRESS SAMLMAIL U�SEZONE /OCCUPANCY Bl�m PGS
CITY TEL.NO,
CONTRACTOR �.�� Jawic5 CO.IMP.NO.
ADDRESS 1510 ! b ws-Li_A1/A5' JOB NO.
CITY g�12p" TEL.NO.&M XoqIi 144 TRUNK PERMIT NO.Mo4T '
REGISTRATION NO./192,,�o COUNTLEGAL
Y ROAD PERMIT N0.
DESCRIPTION LOT NO. �® STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT / ' � ® INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT S NOON LOTS
W
CHARGES
• USE OF
BUILDINGS CONNECTION CH GE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSEMENT F
PUBLICSEWER @ $ 3.50 A t-0 RECEIPT NO. I ATE IBY
HOUSE SEWER CONNECTING TO
_ PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.0R EX PTN RECORDED
_WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO./ DATE BY
_SEWER OR DISPOSAL SYSTEM 1.00 /
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM - 1.00 ,,CONtgC,T12N DATA r. r
SEPTIC TANK,SEEPAGE PIT OR Jed(e,�S QGc�fear 1.YI r-1 CA,U
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYW ELL
SPECIAL CONDITIONS ONLY 2.00 MANHOLE REFERENCE
UPPER LOWER
TY
OWNERS PERMIT ; I 00 E OF CONNECTION LENGTH.FROM
// , CURB P.L.w�.r /,r.�•Z�����M.L.TO P.L.
r •
AUTHORIZATION TOTAL FEE 4 N(V
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DAT
DWELLING TO THE PUBLIC SEWER A
SIGNED THIS----------------------DAY OF...----------------------------------------19...-... NEW HOUSE SEWER
OWNER ORR CONNECT ADDITIONAL '
OWNERS AGENT._..------�r""-�------------------........----^-•�•---------..:._
BUILDING OR WORK
1� ��' r SEPTIC TANK,SEEP.PIT(S)
ADDRESS..-.-.--..-. AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL[ DRYWELL
CAT
A NON 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 DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CA FORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE
FE,
RESIDE IAS PROPERTY. BACKFILL SEPTIC TANKS E]
SIGNATURE ® SEEP.PIT(S)C] CESSPOOLS E
OF PERMITTEE---- _ -•----.....-•.... - -- - -
76A642A 663 7/53