HomeMy Public PortalAbout10945 FREER ST_Sewer__ DEPART OF OOUNW IRNMNEE8 SEWER-SEWAGE DISPOSAL 1
DMSION OF BUELDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGEL
WILLIAM J. FOX, C43UH-rY ENOIHEER BUILDING
ADDRESS
FOR APPUCAU1,10 RLL IN LOCALITY
BUILDING NEAREST
ADDRESS CROSS ET. /}
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DI A SERIAL N0. / �9RMIf c
CRO 98 ST. RECEIVE Y R�a�tr lama DA Ittil J
OWNER d
PAIL
ADDRESS USE ZONE OCCUPANCY
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01 Ro. S
CONTRACTOR
OIr CO.INP.N0.
ADDRESS
JOB NO.
CI TEL TRUNK PERMIT NO
STATE
RE019TFATON N0. COUNTY ROAD PERMIT NO.
LEGAL 7
DESCRIPTION N ZQ STATE ENCRCAOHMENY
PERMIT NO.
BLOCK 0& TRACT INDUSTRIAL
WASTE APPROVAL '
SIZE OF LOT 0-OF BLOBS.
NOW ON LOT OHARB
USE OF
BUILDINGS CONNECTION CHARGE E
NO. DEB ION OF WORK FEE
REIMBURSEMENT FEE
HOUSE BfiWER CONNECTING TO
PUBLIC SEWER III 6.61 RECEIPT NO. ATE BY
HOUSE BEWLtR CONNE6fING
PRIVATE DISPOSALSYSTE■ IAO
CONNECT AD IONAL BLDS_OB D CEPTION RE RDED
WORK TO HOUSE SEWER 1.00
ALTER-Off-kUPAIR rXIBYINGDATE BY
SEWER OR DISPOSAL SYSTEM I.M
DISCONNECT AND ABANDON AEWER
AND ORDISPOSAL SYSTEM I.00 CONNECTION DATA
SEPT 0 AN
PITS AM0D OR 'STATION DEPTH
W
SPECIAL CONDITIONS ONLY 2-M el jMANHOLE REFERENCE
SHR LO W E R
TYPE 0 R Iq� LENGTH FROM
OWNERS PstmrT 1 00 SP.tC Y.L TO P.L �O
AUTHORIZATION TOTAL FEE k5-e)
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO TH PUBLIC SEWER
SIGNED THI AY MEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AG irUILDING OR WORK
REPT TANKI SEEP.PIT(S)
ADDRESS AMD R DRA NFIELO
' HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL E]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTfiQ REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS SEWA4 DOJ
WA
SYSTEM
1 HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY DISCONNECT PLUG AND
AND STATEOF CAL1F0 MIA OR THAT AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABOVE D GIBED R NT PQOPE LL SEPTICTAP ❑
SEEP.PIT(S)o CESSPOOLS
SIGNATURE
OF PERMITTE
TEA64113 60 1/63
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