HomeMy Public PortalAbout10944 FREER ST_Sewer__ tea:... APPLICAT OR PERMIT
COMITY OF LOS ANGOM SEWER-SEWAGE DISPOSAL 1
MARTMM OF COUNTY ffifC GCM
BUMbMG AND SAFETY MV1SZON BUILDING
A. t
ADDRESS fVCOUn t
[
D.GMFF�M 900 °a tflCAUTT
AEAIEdT
FOR APPLICANT TO FILL INcQos>s
DESCRIPTION LoT Ro. --3 mm C E L
BLOCK TRACT ' kDDQESS t7 V/�
R0.OF BLD GI.
SIZE OF LOT NOW ON LOTWSTATEZ�"EIOREj
ITT THL NO.
USE OF
SUILDIN YAP FRO BT
CONTRACTOR KAD°� Colum ION DATActrr r� TIL No.OL . �' DEPM
M NCK `� UPREGISTRATION 110. J
No. D
900
CONVECTING TO
PUBLI 0o Trn OF CONniCTI011 LENUTH FRO! a
SEPTIC T [,SEEPAGE PIT OR T. CURD LL TO P V
PITS AX OQ DQAINFIELD
OVERFLOW SEEPAGE PIT DRAINFIELD
00
HO SE COnMECTt a TO P.C.Y0.
CO.INP.110. JOB NO.
•onQX TO ADD�T10llAL BLDG.OR 0 SIM TRUNK fEUIT NO. ROAD.PERMIT N0.
• RX ru HOAU EOSh7E�Rn HOUSE STAT[iNGROACHYp[T
PERMIT Y0.
INDUSTRIAL
WASTE AFPROY
CHARa
OWNEWS Pmm P 00 CONNECTION CHARGE FEY
AUTSOBPdATION I TOTAL FEE REISIBURSEIENT Fo
1 HAVE AT THIS DATE A COXTAACT WITH THE HEREIN ED'CON-
TRACTOR TO CONNECT THE ,BOYS DESCRIBED ¢ISTINQ DWELLING APPROVALS DA INSPECTO SIGNATURE
TO THE PUBLIC SEIYEQ.
SIGNED THIS- RAY OF la_ NRW HOUSE SEWER
OWVEQ OR CONNECT ADDITIONAL
OWNERS AGIVT BUILDING OR WORK
C TAN EEP
B .PIT(9)
ADD12MU =OQ DQAINFIELD
1 HEREBT ACKNOWLEDGE THAT 1 HAVV READ THIS APPLICATIOA
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COYPU CESSPOOL DRTWEL
WITH ALL CCQqUIITY ORDINANCES AND STATE LAWS REGULATING AI SEWER OR
LDXKD
ANb SEWERS. ALTEk,SMAG DI lE.R OR
CERTIFY THAT I AN PROPEILT IKGIIT[IIED AID/OQ DI[CONdECT PLUG AND
l REQUIRED ST LOS AVG[LES COUNTY AND �TATI OF ABANDON HOUSE SIWE>!
OR THAT 1 Al THE LEGAL OWNE
R
OF THK ABOrQ
RYIID PROPlDZTi. C[FILL C TANS
.PIT D CYSSPOOLS
m' VALIDATION-) ROBERT A. WOOD _
CL L 0. /�CIiE/J iUPERVWINO MACHANICAL KNOINMM
�1�2 5 6 7 PLky 0 D 7.0'0
r -
;;i��RMIT
7mos!A!4!D APPLICATION FO:R -
COUNTT OF LOS ANGEUs SEWER-SEWAGE ISPOSAL
MAETUMM off' COON-11 ENG
EUbD�� AND BPI= DIVISION BUILDING
]Q���. ADDREE!
�:jM D.= �— LOCALm
' FOH APPLI TO
LEGAL
DESCRIPTION .LOT 110.
BLOCK TRACT WL
ADDRESS
NO. F BLDGL
SIZE OF LOT X07 On LOT C
USI OF
BUI InGt DLSTRICT N0. ORD MAK R
CONTRACTOR
ADDRESS CONIG=ON DATA
Crff L no p I DEPTH
STATE WLHOLE RHFEREMCI --'
REGISTRATION NO. COUXTT
no R O
HOUSEC( �CAXXECTI G TO
PUBLI ShTER '00 TTP% OF CONVECTION Lam FROI /S
IC TAANI(,SEEPAGILPIT R T. CU K. NJ,TOP C1
,TIC
0 LOW SMPAGIIPIT DRAIXFIELD
0 ER CONN I G TD P.C.NO.
�(�1 rlTrD 3 �CIAIL/�� 14 Co.IIP,n0. 1:73.1 JOB N0.
CORk �1 0USR SEWERBLDG.OR TRUN[PERMIT n0. ROAD PEUIT 8Q.
1 0 AX HOUSE STATE ENCROACHM"T
1 PESIIT X0.
INDUSTRIAL
TAM AKPROVA
�r�c�. CHARGn
ovn% II$ PERMIT COXRXCTION CHARGE FU
AUTSORMnON TOTAL FEE REINBUSSENEXT FQs
I HAVE AT THIS BATE A CONTRACT WITH THE HBSIEIX )IAIED CON-
TRACTOR TO coN ECT THE ABOVE DESMBED _�1 IT1114 D7EI-MING AMOV= DATL IRWECTOR'N SIGIIATURE
TO THE PUBLIC SEWKR.
SIGNED THIO _DAY OR 19T_ nn HOUSE NEWER
01N ER OR COX DITIONAL
O7NIllf AG otT� BUILDING tlR 70 RK
ADDRESS C TME,SEEP.PIT($)
AN R DRAINFIRLD
1 HEREDT ACKNOWLEDGE THAT I HAV�[ D THIS APPLICATION
AND STATI THAT THE ABOVE IS coANDAGM TO CONPLT ClSSPOOL El MZTWELL Ll
WITH ALL COUNTT ORDINANCES AND STATIZ LAWS REGULATING ALTER.tEPAIRR,iKWER OR
KLUIBING MD SEVERS. "AGE DISKO>y/1L STSTE■
1- HEREBY CERTIFT THAT I AM KROKERLT RIGISTKRED AND/OR DISCONNICT PLUG AND
LICENSED AS REQUIRED BT LOS ANGELES COUXTT AND STATE OF ABM DON HOUSE SEWXR
CALIFORNIA OR THAT THE LEGAL OWKM OF n BACKFILL( C TANKS
DESCRIBED REBID PERTT. SEEK, L D CEEDP00
EIGNATURa
OF PKRKITTKE TZ-7 1
VAIMATIO ROBERT A. WOOD
( Qu[ I XUPVI11Na MECHANICAL RTS GLNXIOt —
1 :r
256a Ev,r11 1 a 2 5.0 0
cunt 4 APPLICATION FOR PERMIT
COQ OF LOS ,111MELSB SEWER—SEWAGE DISPOSAL
DUAarMm.cr r- mQrl Mxcwmm
BUMDM AIM SAF= DON u=G
LOCALM
immom NEU=
FOR APPIICANT TO FILL IN CROM ST,
LEGAL
DESMPTIOJ L.OT#0. O�NEII
BLOCK TRACT WRW
L
BIZ$OF LOT 10. N LOT CrTT TEL NO.
{11E OF
BUILDINGS DI sylu CT NO. d Ur �r p BY -
BK .�DATA
CORTYACTdt !<
ADDRESS CoRlcs=O
cm 3jL No. Q 4T'ATION DEPTH
REGISTRATION eo- 0 J"HOLE RKFERFMC]t r
no D RJPTION OF WORK FEE
�0 3 e XnHcrina To
u� c S moo
SEPTIC T Ml:,SEEPAGE Pr't 09 T t1 P$ OF ry 0■r t FRO)A
PITS AAD OR DRAINFIELD
OY$LFLOtr SEEPAnQL.GE PIT DRAI FIELD
HO SE SE1/2R COMXECTI G TO P.C 0.
PRIXXE D,�l$ �I n/�L CO.IMS,No. JOB No.
YORK 70 HOLIIIE 501WLD0.OR0 SIM
TRUNK PERMIT 110. RD/D Pita■IT 1(0.
IR ANDON HOUSE STATE ENCROACHMENT
SylFTE -9 DO PERMIT NO.
INDufTRIAL -
FRoYA
CHARQU
( WYm" k:OT)gLL
F�Moo CONNECTION cIOLRON FEN
AUTHORMTIOIIFEE Rn■BURSE■ANT Em
1 HAVE AT THIP DATE A CONTRACT WITH THE HEREIN NAM-BD CON- -
TRACSOR TO CNXE TH$ ABOVE DESCRIBED HYil1'TIMG DWgL HR APFROV of .DATE INSPE9T0R GNATURS
TO THE PUBLIC
SI6NEU THS AY OF �" NEW HOUSE S WER S-�'J' y T'
OYNIE$S�G CONNECT Al)DITJO L
BBUILD``INGAA1IiO--��B,,WORK
ADD A OC DIA IMI.PIT(a)
I HEREBY ACKNOWLED69 THAT I HAYE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLT CE"nOl. Q DRTWEL
WITH. ALL CCppUNTT ORDINANCES A" $TATE LAWS REGULATING
PLUMBING ANb SLvu-s ALTT�ER�REPAIRaHWER-0R T Hapt CERTIFT THAT 1 AN PROPERLY REGISTERED MD/0R SEWAGE DISPOSALSTSTE�
LICENSED AS REOUIRrW LA AN CQUNTT AAD ATE OF DISCONNECT PLUG AMD
CALIFOAN-IA OR ■ H OF ABOVE ABANDON HOUSE SLIER
DHS BED REBID P BAC ILLSE C TANKS
SIGMURE T • DES➢.-PIF f CESSPOOLS
OF PE MI /
VAUDATIO ROBrR r A. WC5QD
Qi. L Q. ,SUPMRYISING blXaiAM"L INGUU= .
LT
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