HomeMy Public PortalAbout9564 BISBY ST_Sewer__:° APPLICATION FOR PERMIT 1
I)VISION or BUILniNG ANI) SAFM SEWER—SEWAGE" DISPOSAL
D•—ft •af of CoImtr Engin r
Com of LQ* Anooks BUILDING
JOHN A. LAMEIE, CouNTY ErfGINZMR �RIJIM r
m CASSATI•D.GR]P'FIN, 9ur-roe BUIL.Drma pet f'_15
LOCALITY
FOR APPLICANT' TO £ILI: IN =SST. - C!
LEGA[
DttBCRIPTION LOT X0. " O"IER
HAIL
BLOCY - TRACT - ADDR5318
N0. OF BLDGS.
SIZE OF LOT NOW on Lor City ML NO. / `!-�5
USE bF
BWLDIXGS DISTRICT NO. GROUP KAP
� BK PG
CONTRACTOR - - 3
CON ON "nax�
ADBREJa ,�y� Q
STATION 7 l7 DEPTH
CITY TH N0. MANHOLE REFERENCE UPPER
❑ STATE LOWER
RTC61SfRAT10N N0, ❑ COUNTY .
No. DtSCRIPTION OF WORK FEE
HOUS2 SEINER CONN CTINGTD TYPE OF CONNECTION LENGTH FROM
PUBLICOER S.SO
Y- CURB P.L. K.L. O F.L.
�
SEPTIC TANK,SEEPAGE PIT Op
PITS AND/ORD N-FIELD
OYERFi SEEPAGE PIT,DRAIXFIELD CO. I[P. NO. JOB#OO.
E7C�N.,CES9PQ L,ORYWEL MANHOLE ® L.UO . .
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYBTEY ;t.bb• _ TRUNK PERMIT O. ROAD pF411drT NO.
CONNECT ADDITIONAL BLDG.OR �1 STATE ENCROAGHIENT
WORK TO HOUSE 3 ER ® 1.00 Y PERMIT N
ALTER,REPAIR OR ABANDON HOUR INDMIT N LL,, -
8 OR DI9o.
POSAL,SY37EY @ 1.00 WASTE AP�ROYAt
CRARGES
CONNECTION CHARGE FEE "
OWIfEII'S Pmmrr ; t 00
REIMBURSEMENT FEE -
AUTHOEIZATION TOM FEE O D -
I HAVE AT THIS PATE A COnTk.ACT WITH TH-E HEREIN NAMED Coll- APPROVALS DATE INlPECTOR'$9IGNATURIi
TRACTOII- TO CONNECT THE ABOVE DESCRIBED $ICISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER _
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BU LDING OR WORK - -
pWNt_RS AGENT SEPTIC TANK,SEEP,PIT{9)
ADDRESS IND/OR DRAINFIECD -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CEggP00L❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REG_ILAT4NG ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. EWAGE D "0 A SYSTEM '
I HEREBY CRRTIFY THAT I IM.PROPERLY REGISTERED AND/OR DISCOIINECT PL G AXD -
LICENSED AS REQUIRED B.Y LOS ANGELES COUNTY AND STATE OF ABANDON HOPS G A_ND
CALIFORNIA OR THAT I AN THE LEGAL OWN TE OF ,
DESCRIBED RE9IDENTIA pR0 QACILLlEPTC
TANKS❑
SIGNATURE
P.Pir(S] ❑ CE98 OW❑
OF PHRYI
JOHN A. LA SIE, COUNTY ENGINEE14 V AVON ROBERT A. WOOD, CNF[F PL.BG. INHP[CTOR
CL ■,0. C"H - -
� 7 1 2� MAY 7 4 2.17 0 10