HomeMy Public PortalAbout9154 BIDWELL ST_Sewer__ }
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7eAe�D APPLICAT ON 17OR' PERMI
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COUNTY OF LO8 ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGU=
BUILDING AND SAFETY DIVISION ■ulLDlna /�
JOHN A. I MRTP._ Coen FADOR K."
vnLLmm & Iffi«�. BnP�mi-fu—ming LOCALITY
NEAREST
FOR APPLICANT TO FILL IN [CRO" I Aa
D[SCRI FTI ON LOT NO. OWNER
-MAIL
BLOCK TRACT ADORES■ L
NO. OF E GS,
SIZE OF LOT NOW ON LOT CITY 'QL. NO.
USE OF DISTRICT NO. GROUP MAP "CDC EASED DY
■U ILDINGf
}r�� DK PG
CONTRACTOR L
ADD CO TTON DATA
ATION D[FTH
CITY
ATI U PPER
REGISTRATION NO. COUNTY MANHOLE REFERENCE _
No. DESCRIPTION O WORK FIE TYPE OF ION LENGTH FROM
HOUSE SEW[R'CO NN[CTING TO Y. C P.L M.L.TO P._
'PUBLIC SEWER [S•00
■ C IrANK■ [PAG[ JOS NO. //��
FITS AND/OR DRAINFI EL.D 0 ZI0.00 CO.IMF.NO, y
HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PRMTT NO. �f S "Yf llix
PRIVATE DISPOSAL SYI
STEM 0 SS.00
CONNECT ADDITIONAL■ .OR AFFIDAVIT fAnn LAIIIS[IT RECORD.INSTR.NO. DAT= O
WORK TO HOUSE SEWER 0 53.00 UFj
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,C"SPOOL,DRYWElL,MANHOL[0 $5.00 H
AL A ORA O HWY.OR ST.WIDENING
HEWER OR DISPOSAL SYSTEM 3.00 STATE ENCROACHMENT
ER
PMIT NO.
INDUSTRIAL
PM-ET s 200
WAST[APPROVAL
R
CHAGES
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�OVPNEH'S AJ HOBMTION TOTAI. FEE CONNtCTION CHARGE F[[
'I HAVE AT THIS DATE A CONTRACT WITH THE HOM[IN NAMED CON- REIMBURSEMENT f[[
TRACTOR TO CONNECT THE A■OVE DESCRIBED LXILTING DWLLLINO
TO TH[ PU DTIC SEWER.
APPROVALS DAT[ INSP OR'■eIGNATURE
OWNERSIGNETHIS 1G_
OWNER OR NEW HOUSE S[W[R /
OWNERS AGENT ��� CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS SEPTIC TANK.SEEP,PIT(S)
1 HERESY ACKNOWLEDGE THAT 1 HAVE R[AD THIS APPLICATION AND/OR DRAINFI[LD
AND STAT[ THAT THE ASOVI I■ CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STAT[ LAWS REGULATING
PLUMBING AND SEWERS. CESSPOOL ❑ ORYW[LL
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REO O
■Y LS ANLL COUNTY HD STATE OF SIWAG[DP
ISOSAL SYSTEM
CALIFORNIA O AT I M TH[ LEGA N R OF, ND INTEND TO DISCONNECT PLUG AND
RESIDE IN, ASO DESCRIBED AL OP[RTY. ABANDON HOUSE S[W[R
SIGNATU R[ ■ApKFILL S[PIU TANKS ❑
OF PERMI u CLfSPOOL■
VAI.IDATIO ROBERT A. WOOD
cK. M.O. CASE{
SUPERVISING MECHANICAL ENGINEER
0 0 8 1�10 HAR30 1 0 0 7,00-
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