HomeMy Public PortalAbout10859 FREER ST_Sewer__ ' a1dPA nMNT OF QOUNTY ExGRTMM SEWFR-•SEWAGE DISPOSAL 1
BiYISION OF HUnLDING AND SAFETY PERMIT APPLICATION
OOUNTY OF I.08 ANG IMS BUILDING 1
WILLIAM J. FOX, COUNTY EN13IN[[R ADDRESS I O Qi �C"'let S T
FOR APPLICANT TFlLL IN NA
BUILDING an �� NEAARESTEST
1
ADDRESS CROSS T.
f
LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO.
NNARE f A 2 z u5 2 - S
CROSS
ECEIVED BY Ready for lmsp*aUea DATE ISSUED
OWNER
y `2. - -2-t-J
MAIL -}� USE E OCCUPANCY MAP
ADDRESS Q A�] , �I�yl BK PS
CONTRACTOR CO.IMP.N0. i -A l — 1
ADDRESS JOB M0."
CITY TELNO. h� TRUNK PERMIT NO.
^ ATE
REGITRATIOM M0. +. COUNTY ROAD PERMIT NO.
LEGAL I (� -3 STATE ENCROACHMENT
DESCRIPTION LOT NO. 4!i CSr PERMIT M0.
BLOCK TRACT Z 4r,c) INDUSTRIAL
APPROVAL
OB
SIZE OF LOT 4�� x Z�� NOW OM LOTa CHARGES
USE OF
BUILDINGS �y �` yyG OONNECTIO EFEE
NO. DESCRIPTLON OF WORK FEE
OUSE SEWER CONNEOTIN TO REIMBURSEMENT FEE
PUBLIC&EWER ! s IL" RECEIPT NO. pim
BY
Bit R COWN1513TIliGTO
PRIVATE DISPOSAL SYSTEM IAt
MI OM L EXCEPTION RECORDED
WORK To HOUSE SEWER 1.00 N
ALTER CRR PAI DATE BY
SEWER OR DISPOSAL SYSTEM 1.08
DISCONNECT AND ABANDON SEWER
AMD OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
TANK,SEPTIO PIT Ok i
PITS AND ORDBAINFIELD 2Oa STATION DEPTH
C 0 L RYW LL
SP[OIAL CONDITIONS ONLY 2.E0 1 M PPE EFERENCE SWAMP
TYPE 0 UR CTION LENGTH FROM 1
Y. CP.L M.L.TO P.L. G
OWNERS PE;Lmrr $ 1 00
AUTHORIZATION TOTAL FEE 4,1 4-ri
I HAVE THIS DATE CONTRAOTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNEOT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PU LIO SEWHR
SIGNED THIDAY OF 19 NEW HOUSE sriw¢Q
OWNER OR OONMECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
* SEPTIO TANII((,SEEP.PIT(8)
ADDRESS AND/OR DRAIMFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CEUPOOL[] DRYWELL
CATION AND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND TATE LAWS ALTER,REPAIRjEWER OR
REGULATINQ PLUMBING AND SEWERS. SEWAGE DI&PO LSYTEM
I HEREBY CERTIFY THAT IAN PROPERLY REGITERED DISCONNECT PLUG AND
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT 1 AY THE LEGAL OWN-
ER OF THE ABOVE DE80RIBED RESIDENTIAL PROPERTY. _6KCRIFFEL SEPTIO TANKS
SIGNATURE i SI EP.PIT(8)� 0ESSP00 LS
OF PERMITTE
Te�ea:♦ 663 7/�Q� �l✓"t.�L. Y*. '�y Q����
a� �
rf4;;,,�, APPLICATION FOR PERMIT
nrvmON OF BUI ING AND sA r SEWS R—SEWAGE DISPOSAL
D.p=ftmmt of C -tr Enub- r
Commtr of Los ASN BUILDING `
JOHN A. L.A?ABIE, COUNTY ENGINEER ADDRESS
C.ASS,AT7 D. GRIFFIN, Sur-T OF BUILOINU LOCALITY
FOR AMICANT TO FILL IN CROSSE SST.
VAL OWNER
DESCRIPTION LOT NO.
RAIL
BLOCK TRACT ADDRESS
NO.OF BLDGS. ,
IZE OF LOT NOW ON LUT �-
CITY TEL. NO.
USE OF
BWLD}NGB DIhTRICT N0, GROUP IAP
CO}(TRACTOR -T F--RK
�PG
ADDRESS OQ TION DAT
�L STATION PTH
CiT7 17 Tom- AO RANHOLE AEFERENCE UPPER ,
REGISTRATION NO. S� S UNn, LOWER
.No. DESCRIPTIQN OF WORK FEE
HO SE SEWER CONNECTING TO TYPE 0 XNECTION LENGTH FRO■
Y. P.L. R.L. TO P,L.
PUBLI S 3.50 _
SE IG T/�XK,SEEPAGE PIT OR
PITS DOR DRAIXFIELD' 10 4 5,00
OVERFLOW SMAGE PIT,DRAINFIELD P.C. NO.
.,CESSPOOL, RYW LL MANHOLE Q #2.00 CO. I P. N0. B NO.
HOU SEWER CONNECTING TO
PRIVATE DISP AL SYSTEM - 1.00 TRUNK PERIIT N0, R AQ P T N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT f
WORK TO HOUSE SEW ® 11.00 PERKIT N0. '
ALM,REPAIR OR ABA�iDQN HOUSE INDUSTRIAL
SEWER OR DISPOSAL SY Y 1.00 WASTE APPROVAL
CHAIGES
CONNECTION CHARGE FEE
Owwa's Pmmrr f 1 00
AUTHOBMTION TOTAL FF.E REI YSUFL7EYEIIT FE=ET Q
S
I HAVE AT THIS DANA CONTRACT WITH THE HERE-IM NAKED CON- AMOVAIDATE INSPECTOR'$SIGNATURE
TRAOTOR TO CONNECT THE ABOVE DESCRIBED EI(ISTINq DWELLING
TO T1119 PUBLIC SEWER. y NEVI HOUSE SEWER _ -
S10NEQ THIS SAY �'G IQ-� / CONNECT AQDITIONAL f
OWNER OR - BUILDING O WORK'
QVWNptS AGENT SEPTIC TANK,S'7P,PIT(S�'
ADPRE" AND/bR DRAIXFLD
I HEREBY AQKNOWLEDGE THAT i HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOYE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,.SE1/ER,O
PLUMBING AND SEWERS. SEWAGE DISPOSAL SY Y
I HEREBY CERT IFT THAT I AN PROPERLY REGISTERED AND/OR
LICENSED AS REOWRED BY LOS ANGELES COUNTY AND STATS OF DISCONNECT PLUG D
CALIFORNIA OR THAT I AY THE LEGAL OWNER OF THE ABOYE ABANDON H USE S
DESCRIBV RESIDENTIAL P OPERTY, �( r BACKFILLSEPTIC TANKS❑
SIGNATURE /(//r SSE P.PIT(S}Q'CESSPOOLS
OF?ER ❑
OF PERMITTEE
JOHN A- LAMBIE.'CouNTY ENGINEER LIDATION -ROBERT A. WOQD, C,HIRY PLEIG. INSPECTOR
c<ci ■.o. wB
G4 7 7 3Lc.' _DEC. 3 4 2.00 9