Loading...
HomeMy Public PortalAbout10941 FREER ST_Sewer__ APPLICATION FOR PERMIT COUxlt OF LQS "rim- SEWER - EWAGE DISPOSAL ' 1 tVAatNMfr OF COUN" sxcMM - - BUMURNG AID sAFETT DriMoN � 10 1 Fr t - T�OO�� IL �>a CoumtT C 8BA1T A QRFM /apo LocALtrT n OE APPLICANT TO FILL IN NEAREST. Welland L�enu6 Law►,. - - - DESCRIPTION LOT NO. 14 oWNERJ B- We r C Ia tru t1-. `Co BLOCK TRACT 24389 ` 'S �Tabriel- Bl .d-- . STUOFI= 1NlowON" 2 San -GabrielM.No AT -0 1, USE OF B Ih DISTRICT NO. GROUP IAP CONTRACTOR 2 ADDRESS 136 N. Bleecker 0—ifiMMON VATA STT TEL N0. PD 8-3024STATION DEPTH STATE, MANHOLE QEFEREXCS REGISTRATION N0. COUNTY �71LOWERNo D 10 R R FEE HOUSE SEWER CONNECTING TO PUBUC SEWER SEPTIC T/,21R,SEEPAGR PIT OR TTPE OF CONNECTION UIGTP. H F$OR IT4 M OR DRAINFIHLD 5,00 T. CURB M.L TO OVERFLOW SEEPAGE PLT,DRAIN LD EITN. CESSPOOL DRYWFLL MANHOLE @ #2.60 HOUSE SEWER CONNECTING TO P.C,N0. PRIVATE DISP63AL SYSTEI 1.0d- CO,IIP,N0. JOB N0, ? CONNECT ADDITIONAL BLDJ.OR WORK TO HOUSE SEWER 01,00 TRUNK PERMIT NO. - ROAD PERMIT NO. C ALTER,REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL STSTE■ 1.00 STATE EXGROACHMENT PERMIT No. . INDUSTRIAL WASTE APIRROVAL ' CHARGES OWNERS 00 CONXEMON CHARGE"a AUTSOEMnON T6TA, FEs -- - a REIMBURSEMENT I HAVE AT THIS DATE A.CONTRACT WITH-THE HEREIN NAMED CON= TRACTOR TO -CONNECT THE ABOYE DESCRIBED FASTING DWELLIXG AMOMS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER SIGNED THIS AY OF - - - - ]9_ NEW HOUSE BE7Ep OWNER ORi - -. - - - -- - - CONNECT ADDITIONAL- ---- -- - - - �^---- - I OWNERS AGENT N-PW BUILDING OR WORK -- - - - ---`- -' - — SEPTJC -DRAINFIELTANJ( SEEP .RiT(S)- _ ADDRH33 -- __ ANO ORb - - - _ ' 1 HMUMT ACKNOWLEDGE THAT I HAYS READ THIS APPLICATION ... Z MD STATE THAT THE ABQVE.kA CORRECT-AM D AGREE TO_LDIPLT CE33POOL - -DRYW1iLL- - - - - - - - .WITH AiCOUIKTT ORDINMCEb MD STATE LAWS REGULATING ALTER,REPAIR,SEVER OR PwNBING AND SEWERS, 'ALTER.REPAIR, SEWER 011- -- I• HEREBT- CHRTIFT THAT I-Al -PROPERLT RESISTERED A]IDJOR SEWAI EZISPOLUG MD LICENSED AS REOUIRID BT LOS AXG LES COUNTT AND STATE OF CAUEEOf�J1 IA Q4R T JJ JR■ E L99AL_OWKER OF THE-ABOVE ABMDONHOUSE S DEECkl13Eb Q$716 L P BACKFILL DEPT C iAmu SIGNATV SEEP,PITS CESSPDOLS OF PER YI - --- - - m. - -- -- -� ALIDAMN - ROIBLkTomL W605 — - ■.0. Cw- OUPINVIAINO MECHANICAL LNGINECR - - 5 7-7-1 ER- E71-5 10 A - J -5.0.0 ► �