HomeMy Public PortalAbout10858 FREER ST_Sewer__ R DEPAICTAUM4T OF OOU?iW 1CNc02fEZR SEWE"EWAGE DISPOSAL 1
DMSION OF BUILDING AND SAFETY PERMIT APPLICATION
OOUNTY OF IAS AN(M.
WILLIAM J. FOX, COUNTY ENOINIXR BUILDING el-
FOR
r
ADDRESS
FOR APPLICANT TO FILL IN LDDAUTY
BUILDINGMEANEST /
ADDRESS CRO as ST.
LOCALITY DISTRICT NO. SERIAL NO. P RMIT M0.
NEAREST A l Llq 1.20 3 S
CRDSS aT. r(J
RECEIVED BY Brady hr Irsprrtls■ DATE ISSUEp
OWNER C 3
TAIL
46V / 4
USE ZONE OCOUPAMOY MAP
ADDREBSfBK PG
CITY TELNO_
CONTRACTOR
00.IMP.M0.
ADDRESS S-133 "tiov-4A
JOl!N0.
CITY TE 0. TRUNK PERMIT N0.
STATE
REGISTRATI M NO. COUNTY ROAD PENT NO.LEGAL' . Z
DESCRIPTION LOT NO. O PT -J I- STATE ENOSOACHMENT
PERSIIT M0.
BLOOK TRACT !�Q+Z. INDUSTRIAL
WASTE APPROVAL
0.BF RLD
SIZE OF LOT ,') 5 / ' J MOW OM LOTS .Z CHARGES
USE OF
BUILDINGS l�i�'���(, _00WOTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOU SEWER OONNECTIMG TO REIMBURSE EE
PUBLIC SEWER • >Lq RECEIPT NO. D BY
HO S tE*ER66_NWt&nN8 TO
PRIVATE DISPOSAL SYSTEM I.91
OONNEOT ADOITIONXE BLDS.0R EXCEPTION RECORDED _
WORK TO HOUSE SEWER 1.90
A E��SEPAIS EXI NC• DATE BY �-
SEWER OR DISPOSAL SYSTEM Im
DISCONNECT AND ABANDON SEWER
ANDCH DISPOSAL SYSTEM 1.96 CONNECTION DATA
SEPTIO TANK. EP B
PITS AMD OR DRAIMFIELD 2.50 STATION , DEPTH
CESSPOOL—DRYWELL
SPECIAL CONDITIONS ONLY 2M �3 iUPHOPERLE REFERENCE
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ 1 00 Y. — CURB �✓! PA- ----MA_TO P.L
AUTHORQATION TOTAL FEE 5-n
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPEOTOWSBIGNATURE DATE
DWELLING TO THE PUBLIO SEWER
SIGNED THISj PA &4 .19ja NEW HOUSE SEWER '�'• /". r
OWNER OR + CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESSSEPTIC TANK,SEEP.PIT(S)
AND/OR DRA NFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIG APPLI- CESSPOOL❑ DRYWELL
CATIONAND STATE THAT THE ABOVE IS OORREOT AND AGREE
TO 00MPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAgE DISPOIIAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRI� RESID NTIAL PROPERTY. L 1 AN
SEEP.PIT(S)❑ OESSPOOLiJ[]
SIGNATURE
OF PERMITT r
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