HomeMy Public PortalAbout10843 FREER ST_Sewer__ DEPARTBIENT 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
ADDRESS / 0,S
,S F
FOR APPLICANT TQPLL IN LocAu7Y
BUILDING _ e�1 NEAREST
ADDRESS ,, �/`�L�LYI. CROSS ST.
LOCALITY DISTRICT NO A SERIAL NO. PERMIT NO.
NEAREST �� A S
CROSS ST. C�
�RfEC'E}I�fV�JED BY Ready for Inspection DATE ISSU�E'D`(�
OWNER c
MAIL /� ��� A_ �Sp �� USE ZONE OCCUPANCY BK MAP PG
ADDRESS G G lTr _
CITY U TEL.N0.-141 13
t�
CONTRACTOR .� N0. J_3 _3 /
CO.IMP.
ADDRESS .� _ tw JOB.NO.
CITY - TEL.NO.
(, TRUNK PERMIT NO.
REGISTRATION NO. �I7 Cl—?—(:S `f S�N•TY
ROAD PERMIT N0.
LEGAL '3 STATE ENCROACHMENT �
DESCRIPTION L07 NO. PERMIT NO.
BLOCK TRACT A rS ` 3 - 2 3 INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT "4 NOW ON LOT NO.OF BLDGS. CHARGES
BUILDINGS 7� /1
USE CONNECTION C GE FEE .�
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $ 3.50 RECEIPT N0: D I BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO' I 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 p�
PITS AND/OR DRAINFIELD 2.00 STATION ��y DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2.00MANHOLE REFERENCE
91- W ` WIPO-R— LOWER
TYPE OF CONNECTI• Oy— LENGTH FROM
Y. CURB !,— P.L. M.L.TO P.L.
OWNERS PERMIT $ I I 00
AUTHORIZATION I TOTAL FEE I G
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-------fCL......DAY OF_.' Q A'Cr Igic F NEW HOUSE SEWER
CONNECT ADDITIONAL
- - - - -
OWNER OR i BUILDING OR WORK
OWNERS AGENT.... __......-.
SEPTIC TANK,SEEP.PIT(S)
ADDRESS......... _ __... __Y�r.4'X._. ..__ _ AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL E] DRYWELL
CAT
IONAND 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
I 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 CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
/� n SEEP.PIT(S)� CESSPOOLS�
SIGNATURE &T� d5: / -----
OFPERMITTEES?/ - "r - ...-...-
76A642A 663 7/53 010 f
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