HomeMy Public PortalAbout9549 BISBY ST_Sewer__ 76A"4=4sAPPLICATION tOR PERMIT
DAMON OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL .
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WM..I. FOX.COUNTY 6NOINmI SyCA MATT D.GRIFFIN. furT ow■U2ptme I9-0" T
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DESCRIPTION LOT N0. OWNIIR {
BLOCK TKACTko RAIL
N0OF ADDRESS
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EIZ[OF LO NOW ON LOT CTTY T[?L, NO, �
U➢H OF
B I DI GS oe DISTRICT N0, GRyyq YAP
CONTRACTOR BE
ADDRESS f��ff77— CONNECTION DATA
CITY TEL. NO.' U VIJJOVe STATION ^ j /\L* DEPTH
D Q STATE MANHOLE REF'ERENCII UPPEA
RGGBTR
IATIOPr X0. COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO;°ueuc SEWER � a.no TYPE ECTION LENGTH FROM
Y. CURB P. Y.L. TO P.L.
HOUSE SEWER COX-XECTIMG 70
PRIVATE DISPOSAL SYSTEM 1100
CONNECT ADDITI NAL BLDG. OR P. G. N0.
WORK TO HOUSE SEWER 1.00 co, LII P. N0. JOB NO.
ALTER OR REPAIR E119TING
SE7EER OR DISPO AL SYSTEM 1.00 TRUNK PERMIT N0. ROAD PERMIT NO.
DISCONNECT AXq ABANDON SEWER STATE ENCROACHMENT
I AND/OR DIBPOSA SYSTEM 1.00 PERMIT N0.
1 SEPTIC TANK,SEEPAGE PI OR
PITSAND/OR DRAINFIELD .00 INDUSTRIAL
W
CESSPOOL-DRYELL IN APP
ROVAL
SPECIAL CONDITIONS ONLY 2.00 CHA$GES
OvnuwS PmaT S l 00 CONNECTION-CHARGEHAR-CHARGEFEE
AUTHORIZATION TOTAL FES REIMBURSEMENT EEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED ELIjjINf DWCI.I,ING APPROVALS DATE INS R'S SIGNATURE
TO T11E PUBLIq S ER
SIGNED THI AY OF Ig MRW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL ,
OWNERS AGE BUILDING OR WORK
SEPTIC TAME,SEEP PIT )
ADDR
AND/OR DRAIXFIELDH
1 H EBACKXOWLHpGG THAT I D THIS APPLICATION-
AND [I DgYWELL[IAND ATEY HA IF
THAT THE ABOVE 18 CORRECT"AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATH LAWS ,REGULATING �� REPAIR,SEER OR
PLUMBING AND SET'�iS. SEWAGE DISPOSAL SYSTEM
1 NERtBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR
LICENSED AS AEOUIRfD BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND _
CALIFORNIA Opp THAT 1 All THE LAiGAL'OWNER OF THE ABOVS ABANDON HOUSE SEWER
DCSCRIBrD R531DS ROPERTY. BACSFILL C
SEEP.PIT S CESS POO
SIGNATURE
OF PENYITT[E -
WI>Li Lew J.FrOX.COUNTY ENGINEER WMATLON R.A.WOOD, CHLQ PLwG' IN,spicrgR