HomeMy Public PortalAbout10864 FREER ST_Sewer__r
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69APPLICATION FOR PERMIT 1
i D'IVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Depark-nt of Com Engle .e
County of I" Engels FA.DR'ING O
JOHN A. LAMBIE, COUNTY ENGINEER ESS
m CASSATT D.GRIFFIN, SUPT OR BUILDING LITY
FOR APPLICANT TO FILL IN BEST
LEGAL 05INER
DESCRIPTION LOT NO.
MAIL
BLOC[ TRACT ADDRESS
X0.OF SLOGS. CITY TE-L. N0.
SIZE OF LOT NOA On LOT
USE OF
BUILDINGS DISTRICT NO. GROUP YAP
L O NT)iA CTO R (J/�
ADDRESS
CONNECTION DATA
� /�rC L 4r � � � .
STATION DEPTH
CITY h„ TEL. N0. L
■MHOLE DEFERENCE
LOWER
REGISTRATION N0. �Z / 0 COUNTY
no. DESCRIPTION OF WORK FET
HOUSE SEWER COXNECTINA TO TTPE 0 CTION LENGTH FROM �Q O
PUBLIC SEWER 3.50
�� Y. UR P.L. Y.L. TO P.L.
SEPTIC TANX,SEEPAGE FIT OR
PITS AMD/OR.DRAIN FIELD 40 S 3.00
OVERFLOW SEEPAGE PIT,DRAIXFIELDCO. IED. N0. JOB N O
EXTN.,CESBPOOL DRYWELL MAN OLE 2.00
HO DE SEWER CO XECTING TO
PRIVATE DISPOSAL SYSTEM 0 1.00 TRUNK PHiYIT NO. ROAD PER M IT NO. C�
CONXE ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEVER 0 41.00 PERMIT N0.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM f 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PST 1 . 1 00
REIMBURSEMENT 1rEE
A THOSILATION TOTAL FEE s'Q -
I HAVE AT THISDATE A CONTRACT WITH THE HEREIN RAYED COX- APPROVALS DATE INSPECTOR'SDIG ATURE
TRACTOR TO COXNECT THE ABOYE DESCR1EED EXISTING =LLING
TO THE PUBLIC 3EVER. MEW HOUSE SEWER i
SIGNED THE AY F CONNECT ADDITIONAL
4gWWEp OR BUILDING OR WOR[
__"_'S A6Elf- DEFTICTANK.PEEP,PIT(S)
ADDR AND/OR DRAINFIELD
1 HEREBY AC"OWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CEfBPOOL❑ DRYIIHLL❑
WITH ALL COUNTY ORDINANCES AMD STATS LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
1 HERESY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REOU1RED BY LOS ANGELES COUNTY AND STATE OF
CALIFORNIA OR THAT I A HE LEGAL OWOF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL F ERTY. BACKFILL SEPTIC TAMS El
71 SEEP.PIT(3) [1 CESSPOOLS[IOF PEkWITT_ '
JOHN A. LAMBIE•Cou ENQtNKKR ALIDATION ROBERT A.WOOD, CHIEF PLma. INSPECTOR
5 6 5 0 bR MAY 2 4 4.5 0 rn