HomeMy Public PortalAbout9548 BISBY ST_Sewer__ APPLICATION FOR PERMIT 1
DIVISION OF BUELDENG AND SAFETY SEWER- SEWAGE D 1 S POSA L
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County of Los Angel" BUt70q
JOHN A. LAMBIE, COUNTY ENGINEER ADDCABSATT D. GRIFFIN, SUr•T OF BUILDING LOC
FOR APPLICAM TO FILL N CROSS T. t
LEGAL / ;:
DESCRIPTION LOT NO. {r
MAIL `
BLOCK TRACT ADDRESS I
SIZE OF LbT „0. OFN LOTS.GYMCITY01 TEL. N Y'GPL
USE OF 9069�
BUILDINGS DISTRICT GROUP YAP
BK G
CONTRACTOR L
ZOTDATA
ADDRESS
CITY TEL 110, STATION DEPTH
YANHOL$REPIItENCE - UPPER
❑ kTATELOWER
REGISTRATION NO. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE 4EWEtR CONNECTING TOTYPE OF CONNECTION LENGTH FROM
PUBC $3.60
Y. CURB PJ- M.L,TO P.L
S �
SEPTIL} TAN R,SEEPAGE PIT OR
PITH A.ND1OR DRAIXFIELD 5.00
OVERFLOW SEEPAGE Pit, DRAIXFI�LD P. C. NO.
EYTN„CESSPOOL DRY-WELL MANHOLE !. 0 ;CO. IMP.110, JOB XO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ 3 1.00 TRUNK P MIT NO. ROAD PERMIT-NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK O HOUSJE SEWER 1.00 PERMIT NO.
1.00 Lt1DUSTmAL
MASTE APPROVAL
CHARGES
• - CONNECTION GHAYGE FEE
OWNER'S PEEMR S 1 00
AUTHORIZATION. TOTAL M REIYBU�RSSEErML?a FEE
T
I HAVE AT THIS LATE A CONTRACT WITII THE HEREIN RAYED CDN- APPROVALS DATE INSPECTOR-S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED U19TING PWJLLING ,
TO THE PLJ"IC SEWER. XE7 HOUSE SEWER' _
SIGNED THIS AY OF 19 CONNECT ADDITIUAL
O"ER. OR ' BUILDING OR MO K
OWNERS AGENTSEPTIC TANK,DEEP,PIT(S)
ADDRES AN /OR DRAtIF1ELb - -
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION SPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAMS REGULATING A1,TE1:,REPAIR,SEW EA QR
PLUMBING AND SETERS. SEWAGE DISPOSAL SY Y
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED 9Y'LO67ANrELES COUNTY AND STATE OFABANDON HOUSES ER
CALIFORNIA Oji TH AN E LE O N THE ABOVE 11,,..LL _
DESCRI RED RESIDE Rb TY, SAE KFIT(SEP❑ CEBSPO O El .
IGXATURE
OF PERMITTEE
JOHN A. L,AMBIE, COUNTY ENGINEER �[gT_ -mATION ROBERT A.WOOb,CHIEF PLB01. INBPYCTOR
J�M.D. we
t ,-2 7 6-7 rpt 10 4 A 2.00 �
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