HomeMy Public PortalAbout10936 FREER ST_Sewer__ cgaoa 8Aa4Io:-asp APPLICATION FOR PERMI
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COUNTY OF Los ANGELES SEWER—SEWAGE DISPOSAL
D$PARTNIENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION euILnING
OH2f A -■*rRtt_ Com ffi ADanue
Of
LOCALITY
NEAREST
FQR APPLICANT TO FILL IN `"°k' ST.
D EBc RIPTION LOT NO. OWNER K /.^
MAIL r
BLOCK TRACT ADDRESS d 7 I
tl0. OF ■LSO/.
11ZI OF LOT HOW ON LOT CITY TIL NO.
USE OFDISTRICT NO. GROUP MAP 'ROC ESSID SY
■Ui LDING■
40 1l DK PG
CONTRACTOR O �r
ADDRESS y7v LG , CONNECTION DATA
g BTAT I O 1� D[PTH
CITY TIL. NO. 7
ATI MANHOLE REFERENCE U"IR
REGISTRATION NO. COUNTY4y f
No. DESCRIPTION OF WORK FEE 'ry"of cotlli[CTION L.ITI TH FROM
HOUSE SEWER CONNECTING TO Y. UR■ P.L M.L.TO P.L
PU/LIC SEWER SE.00 P.C.NO.
/ PTIC TANK.■ AOE P OR CO.IMP.NO. JOB NO.
I•It*AHD/OR DRAINFIELD •10.00
HOUSE/EWER CONNECTING TO TRUNK Ti NO. ROAD'[RM
'RIVATI DI■'OSAL SYSTEM 57.00 ix
CONNECT ADDITIONAL■ G. R AFFIDAVIT TAMN wa RECORD NO. DATE 0
WORK Tb HOUSE■EWER a S3.00
OVERFLOW S[R'A E PIT.DRAINFI[LD
IXTN.,C"SPOOL DRYWELL MA N H OLE 0 $3.00
ALTER. HO HWY.OR ST.WIDENING
■EWER Ov�
� S'00 STATE[HCROACHM —
PERMIT NO.
INDUSTRIAL
WASTE AP AL
CHARGED
OWNER'S PERmTf s 21 00
AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE
'I HAVE AT THISDATE A CONTRACT WITH
TTHI MEREIN NAMED CON- RIIMBURDEiIENT FEE
TRACTOR TO CONNECT THE ASOVE DESCRIBED EXISTING DWELLING
H
TO THE PUBLIC ■ R. APPROV DAT[ I HSPECTOR'S SIGNATURE
/
SIGNED THIS�2.DAY OF &iA 18�
OWNER OR NEW HOUR[SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING ORWORK
ADDRESS
1 HERBY ACKNOWLEDGE THAT I HAVE READ THIS A'PLICATI ON AND/OIC TANK.1 IKLD PIT(8)
AHD/OR DRAINFI[LD
AND /TATE THAT THE ABOVE IS CORRCT AND AOR[[ TO COMPLY
WITHALL COUNTY ORDINANCE■ AND STATE LAWS REGULATING
PLUM RING AND SEWERS. L[SD POOL ❑ DRYWELL ❑
I HERESY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALT[7l.■4/r/[TR,SEW[R OR _ }
LICENSED AS REOUIRED ■Y LOS ANOLXS COUNTY AND STATE OF
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF, AND INTEND TO �AASA:kNQON
ONNECT PLUG AND '
RESIDE IN, THE ABOVE OESCRI■ D R IDENTIAL PROPERTY. HOUSE SEWER
BIONATUR[ ANKS
OF PERMITTEE 1��JI/ CKK P.FIPrTLL SEPTIC) iCESS
POOLS
MMATION ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
- LA(;o 75 5 15 e2 MY 2 4 1 0 D 5.0 0 9
APPLICATION OR PERMIT 1
DDIMON OF BUIWING AND SAFETY S EINE R--SEINAG E- D I S POSA L
D.p-fta.nt of C—iy Engimm
Ca=ty of yo. AAwaw; BUILDING y 4 7y"JOHN A. L.AMBIE. COUNTY ENGINEER ADDRRSS
- ClKR"i rr D. GRIFFIN, SUPT OPr BUILDINU 'LOCALITY
RER
REA
FOR APPLICANT TO FILL IN CROSf DT
OWNER N E8
DSICYIPTION LOT NO.
BLOCK TRACT tAILADDRESS
00
NO.OF BLvGR• CITY TEL. NO.
SIZE OF LOT moll ON LOT
UAE OF Dlfir'RICT XO. GROUP YAP
BUILDING
• BR PG
CONTRACTOR
ADDRESS CO ON DATA
STATION DEPTH /
C�flf L. NO
MANHOLE REFHkENCE UPPER
B--ST71TE'
REGi1THAYIoN hb. ❑ COUNTY
NO. DESCRIPTION OF WORK FL-E
OUSE 8 ER COKNE ING TO r f QF CTI ON LENGTH TROT
PUBLIC SEWER3.50 Q Y. UR P.C. r.L.`f0 P.
SEPTIC TANK,! P//116E PIT OR
PITS /O D IMVIE 3.00
p LOW SEEPAGE PIT,DRAINFIELD CO. IIP. NO. JOB NO.
EETM—CESSPOOL DRYWELL M#XHOLE 2.00
HOUSE SEWER.CONNECTING TO
PRIVA7 DISPOSAL S STEP f 1.00 TRUNK PERMIT 110. ROAD PERM NO.
CONNECT ADDITIONAL BLDG. R - STATE EXCROAC"ENT
WORK TO OUSE f7Y'fiR ® 1'.00 PERMIT AO. '
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISP SAL,SY STE 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OvnM`S PEI3)M $ 1 00
AUMOBIZAnON TOTAL FEE REI>.8uRs2rEnr FEE
I HAVE AT THIS DATE A CONTRACT SMITH THE HEREIN NAMED CON- AMOVAIS DATE INSPECT R'SSIGX URE
TRACTOR TO CONNECT THE ABOVE DESCR BEp 5JISTIKG DWELLING
TO THE PUBLIC SEWER. *E-W HOUSE SEINER
SIGNED THI AY QF CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNER$ AGENT SEPTIC TANK,SEEP,PIT(9)
A DRES D/OR DRAINFIELD
I HERE Y AC OWLEDGE AT I HAVE THIS-A ION SPOOL❑ DRY-WELLE]
AND STATE THAT THE ABOVE IS CORRE D AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND T$ LAWS REGULATING AFTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE QISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY RE64STERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LO AX LES COUX A D OF ABANDON HOUSE SEWER
CALIFORNIA OR TH T Y G OWN THE OVE
DES-CRiBED RESIDE BACKFILL SEPTIC TAX"[ISI4NATURE SEEP.PIT S) ElCuspoOLS❑
OF PERMI
JOHN A. LAMBtE, COUNTY ENGINEER VALIDATION OPER A. WOOD, CHIRP PLBO. INBPECTOR
X.0.
-05 5 0 2D; FEB25 4 '5.5-0 In