HomeMy Public PortalAbout9174 BIDWELL ST_Sewer__ 4tD APPL,ICATIO FOR PERM
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COUNTY OF LOS ANGEL FS SEWER-SEWAGE DISPOSAL
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BUILDING AND SAFETY DIVISION 13UILDING
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LOCALITY
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FOR A.PM IN CROSS ST'
DESCRIPTION LOT NO.
OWNER ,
MAIL
FLOCK TRACT ADDREDS l
Q. OF 2ILDOIN. A
SIZE OF LOT NOW ON LOT CITY f- TEL. NO.
US[ OF DISTRICT NO. GROUP MAP PROCESSED BY
BUILDINGS (^J ■K PG
QQNTRACTOR `�
ADDRESS CONNECTION DATA
CITY I 4-,RIO ION --
3 PIPE R
REGI/TMTI NO. C UNTY MANHOLE REFERENCE
No DESCRIPTIO OF WORK FEE TYPE of C N LENGTH FROM
HODS[ EER SEWER CONNECTING TQ / Y. R■ P.L M.L.TO F.
PUBLIC SWa SC.DD / F.C.NO.
S FTIC TANK.• P G[PIY on CO.IMF. NO. JOB NO. O
FIT/AND/QR DRAINFI" 41510. y ^7 V
HO(1/[/[W�!CON N[CTiNG TO TRUNK PERMIT NO, Rd AD PEIIMIT NQ.�`�J
PRIVATE DI/PO/AL SYSTEM $3.00
CONN[ ADDITIOMA4 •O AFFIDAVIT ■AI"l WOI[E'I RECORD_IN/TR.MO. DATE O
WORK TO HOUSE SEWER $5.00 �FUj
O VIRPIOW SK"AGE FIT,PRAINFI[LD
[7l TN.,CAASPOOL,DRYWILLLMANHO 50.00O..
ALTER, PAI A HWY. OR ST.1yIDQ1ING H
SEWER OR DISPOSAL SYSTEM 13.00
STATE[NCROACHM NT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
hh���B�• CHARGEE
V S PE Mff i 2 00
A=0BI n0N TOTAL FEE CONNECTION CHARD[FEE
'I HAVE AT THIS DATE A CONTRACTWITH THE H[R[I NAS ED CON- REIMBURSEMENT FEE
TRACTO41 TO CONNECT THE ABOVE DERCRIBaI _WoV RT O
DAT[ iNSP
TO THE PUBLIC SEWER. PL�AF7�{ •liy� DR'S SIGHATU R[
SIGNED THLS-DAY
OW1I[R OR MEW HOUSE S[W[R
OWNERS AGENT Cb NN ECT ADd ITIONAL
■U I LD I NV OR WORK
ADDRrS► SEPTIC TANK,NEEP,FIT(6)
I OR
HERESY AC"CIWLKDE THAT I HAVE READ THIN APPLICATION ANO/OR DAINFI[LD
AND STAT[ THAT THE AJIQVX IS CORRECT AND Ab R[E TO COMPLY
WITH ALL COU NCES AND STATE LAWS REGULATING
PLUMBING AND RS. CESSPOOL ❑ ORYW[LL ❑
I HERESY IFY THA I AM PROPERLY STERED ND/OR ALTER. [PAIR.SIW ER'OR
LICENSED EGUIRED Y LOS ANGLSI AND ATE OF SEWAGE DISPOSAL SYSTEM
CALIFOkNIA R THAT I M THE LEGAL OW AILD 1 NO T.O DISCONNECT PLUG AND
READ[ IN, E ACO ESCR4BED RLI P OP AVANDON MOUS[A[W[R
SIONATUR CKFILL SEPT C TANKS ❑
OF FERMI S CESSPOO LC
ALIDATIDIp ROBERT A. WOOD
O.
FG�J-„/ SUPERVISING MECHANIFAL ENGINEER
Y.
OLACO0 8 5P. X30 1 0 0 7.00-