HomeMy Public PortalAbout10912 FREER ST_Sewer__r
C6[D[
7SA641D D APPLIC,ATI N FOR PERMS
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPQSAL
DEPA.RTMEN'T OF COUNTY ENGRCM
B=ING AN]) SAFETY DIVISION BEILD'NG
v�0� h T illRiF._ A.M.
.i jj & lam.�7 F n,Q E
LOCALE
NEARE
FOR APPLICANT TO FILL IN CROSS .
A [
DESCRIPTION LOT NO. • D t OWNER
�� /
FLOCK TRACT yj ADD.alr MAIL 1
tl o. SLOGS.
SIZE / ON LOT CITY TEL. n0.
US[ OF
gEILDINOS DISTRICT NO GROUP MAT R!1iY
BK PG
CONTRACTOR O
ADDRceq 7, CONNECTION D TA
CI
STATION
TIL_
ATE
R[OlXT`(tATION NO. COUNTY MANHOLE REFERINC[
NO. DESCRIPTION OF7 WORK F[[ LaNcIrTH 1,
HOUSE SEW[ ER CONTI[C71NO TO Y TYPE OF CCU RB ON P.L Y.L TO P. 4�J(,, U
SEPTIC SW[R O $5,00 V 7/ - R.C.NO. I
SEPTIC TANK, R AG[SIT OCO.IMI.'0JOE NO.
PITS A1�/DR DRAINFI[LD � fa 0.00 .
HOI,ISE SEWER CONNECTING TO THUNK PERMIT NO. ROAD PERMIT NO
I-RIVATI PISPOSAL SYSTEM I♦ *3.00
CONNECT ADDITIONAL BLDG.OR APFIDAVIT •APR■ w[SDl"I 7tKCORD.'IP4ffTlR.NO. Ealm
WORK TO HOUSE SEWER fS.00
OVERFLOW S[[PAG[Pff,DRAINFI[LD
EATK,,CESBFOOL,ORYWII.LMANHOL[ fB.Po
ALTER,IRXP/klk ON AILANE>OM HOU&dHWM.OR 07.WI DEN NO
S[W[R OR DISPOSAL SYAT[M fa.o.0 STATE[NCjLOAC MENT
PIRMITNo.
INDUSTRIAL
WASTE APPROVAL
PERAQT 2 00
CHAROMS
i
CONNECTION CHARGE FIE
AUTOTiWONffiZAEH'TSION TOTAL FEE
I HAVE AT THi■ DATE A CONTRACT WITH TH[ H[J1[IN NAMED CON- KEIMBURSEMkNT F�[
TRACTOR TO CONNECT THE ABOVE DESCRIBED LXISTING bW[CLING
TO TH[ PUBLIC ■EWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS F 19—
OWNER OR /I NEW HOUSE SEWER
OWNFRS AGENT_ CONNECT ADDITIONAL
BUILDING OR WORK
ADPR{JS SEPTIC TANK,SEEP,PITO)
1 H[RIBE
Y ACKNOWLDGE THAT I HAVE READ THI■ APPLICATION AND/OR DRAI NFIELD
AND STATE THAT THEABOVE IB CORR3CT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATL LAWS RIGULATINO CESSOOL ❑ DRYWELL El
Mn ENG AND SEWERS. P
I HEREBY CKRTIPY TH AY PROPERLY REOISTIRI D /OR ALTER,RLPAIR,SEWER OR
LICENSED AS R[GUI EY S AN0LEE
NTY AND A oilfEWAGI DISPOSAL SYSTEM
CAlIFOAN IA OR TH AM [ LEGAL OF NO NTIND TO DISCONNECT PLUG AND
R[lID[ IN, TH[ V[ D RIBFD IA RO STY.
ABANDON HOUR[SEWER
■SOF P RH 1 BACKFILL SEP[�C TANKS p
SEEP,Prr(E) U c—POOu El
VALIDATION,--)( I ROBERT LA WOOD
l/�/ SUPERVISING MECHANICAL ENGINEER
CK. Y.O. CASH
V ;a 5 2 6 2 ZS FEB 5 1 0 D 7.0 0- q