HomeMy Public PortalAbout9180 BIDWELL ST_Sewer__ . )oma
78AO420 APPLAOOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DIPASTN ENT OF COUNTY ENGINED
B=ING AND SAFETY DrMION Bu ILD I No
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NEAREST ee�'t'r
FOE APPLICANT TO IN `"O"
LEGAL
DESCRIPTION LOT NO. OWNER ,
MAIL
■LOCK CT ADDRESS t
N
SIZE OF LOT NO ON CfTY C T;L. NO,
USE
OF DISTRICT Nd. GROU MAP RD'c S D■Y
SUI LDIHO
OK PG
CONT OR , D
ADD CONNECTIONDATA
clry Ion DEPTH
u PPa
A MANHOLE REFERENCE
R[O COUNTY
N DESCRIPTION OF WORK PEE TYPE OF co Ion LENGTH FROM
HOUSE SEWER CONNECTING TO Y. P.
M,L TO P.L
PUBLIC SEWER 515.00
• PTIC TANK,B[EPAG[ C.O.IMP.NO. JOBe NO.
OR NO H
,ITS AND/OR DRAINFIELD 510.00 lJ
HOUSE■EWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM O 51.00 /1
CONNECT ADDITAONAL BLDG.OR AFFIDAVIT •VRt UM[111117 RECORD.INSTR.NO. DATE }LLWr/1
WORK TO HOUSE SEWER $3.00
OVERFLOW•[RAG[PIT,DRAINFIELD
UCTN.,CISSPOOLDRYWaLMANHOLEa $3.00
AL AlR OR AhAND6M HOUSE 'HWY.OR ST.WIDENING H
SEWER CA DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT
PERMIT NO.
INDUBTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PEBMPI' s Y 00
CONNECTION CHARD[FIE
AUTHOEIZATION TOTAL FEE
'1 HAVE AT THE{ DAT[ A CONTRACT WITH THE H[REIH ED CON- REIMSURSKMENT FL
TRACTOR TO CO [CT TH[ A DE•CRI0ED 77��� RT a
TO THE PUBLIC ■ R. IIOV DATE INSP[ R'•SIGNATURE
SIGNED THIS Y OF iQ_
OWNER OR NEW HOU"[SEWER
OWNERS AGENT CONNECT ADDITIONAL
BUILDING OR WORK
ADD"R` •RTIC TANK,BSlP,PIT(■)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AHD/OR DRAINFIELD
AND ■TAT AT TH[ ABOVE IB CORRECT AND AGREE TO COMPLY
WITH AL COUNTY ORDINANCE• AND STAT[ LAWS REGULATING
PLUM•I SEWERS. CESSPOOL ❑ DRY ❑
I H C IFY THAT I AM P[RLY R[GIST" D AND/OR ALTER,REPAIR,SEWER OR
LICE ALT
I RED BY LOS LIJ COUNTY A STATE OF MI WAGE DISPOSAL SYSTEM
CAL NIA THAT I AM THE L OWNER OF, A INTEND TO DISCONNECT PLUG AND
RES IN, 3 ABOVE DESCRI IDENT I- P PERTY. ABANDON HOUR[BEWER
SIG ❑
OF EACKFILL SEPTIC TANKS
■ER,PITS) ❑ CESSPOOLS
JK.
VALID ROBERT A. WOOD
Y.O. SUPERVISING MECHANICAL ENGINEER
GSH
LACo0086u MAR 3010 D 7.00—