HomeMy Public PortalAbout9570 BISBY ST_Sewer__ ■sawua.sar
"'° APPLICATION FOR PERMIT
a
DIVIMON OF BUILDING AND 9"M SEWER--SEWAGE DI POSAL
CMMIT of 1.08 Angeles BUILDING qa" o B
WM.J. FOX, CouNTY Emomam
CAa1ATT D.CIRFFF K, sur Y OF WUTLDD14 r�7T D j►'/1r�i�
FOR APPLICANT TO FILL IN �eaT
LEGAL. II
DESCRIPTION LOT NO. Cj 4J,-9,4;s .(xsPWA1,9.JGE
BLOCK TRACT RAILADDR
; NO. OF BLDGS. 84/
SIZE OF LO Now ON LOT QEyE/'rp 'f E1. X0. p-ls �
OH'OF
BUII,D.10 DISTRICT 110. GROUP RAP
SK PC
CONTRACTOR
ADDRESS ' C0DATA
CITY J STATION DEPTH
❑ STATE MANHOLE RTiFi.RE]ICE / PPER
REGISTRATION N/ ❑ COUNTY
No. DESCRIPTION OF WORK Fria
HOUSE SEWER CONNECTIMG TO TYPE VECTION LEIIGTH FROM
Y R P. Y.L.TO P
PUBLIC SHYER 3.30
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR P. C. NO.
WORK TO HOUSE SEWER 1.00 CO. IMP NO JOB NO.
ALTER OR R
DJ
EPAIR EXISTING POEAL SYSTEM 1.00
SEWER OR TRUNK PERMIT NO. ROAD PERMIT NO&P.1 �
I
DISCONNECT AND ABANDON SEWER S'1'/('fE ENCpOACHY611T
AHD/OR DISPOSAL SYSTEM 1.00 F MIT NO.
1 SEPTIC TANK,SEEPAGE PIT OR
' PITS AND/OR DRAINFIELD 00 IRDUSTRIAL
CESSPOOL*DR ELL R VA
SPECIAL CONDITIONS ONLY 2.00 CHARGES
CONNECTION CHARGE FEE
OWNER'S s ] o0
AUTHORIZATION I TOTAL FEE REIMBURSEMENT FEE
I HATE HITRACTORTTOSCONNECT EAAB VEDATE CONTRCTEDWDESCR BSD EXISTING ITH THE HEREIN %IL M4 APPROVAIS DATE INW OR'SSIGNATURE
TO THE PUBLIC ;4- NEW HOUSE SEWER
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SIGNED THI AY OF 1JaJa
OWNER OR CONNECT ADDITIONAL
OWNERS AG BUILDING OR WORK
SEPTIC TANK,BEEF.PFT(S)
ADDR d D/OR DRAIKFIELD
1 HEREBY ACXNOWLEDG4 THAT I HAVE READ THIS APPLICATION ,CESSPOOL❑ DRYWELL 0 '
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING 'ALTER,REPAIR,SEWER OR -
PLUMBING AND SEWEA3. SEWAGE DISPOSAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED ARD/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND -
CALIFO4NIA OR THAT 1 AY THE LEG>--' FI
WNOF THE ABVE AS DON HOUSE SEWER
DESCRIBED RESIDENTIAL PLlRTY. / GALLS C Kf ITS T1UIPOOLS
SIGIU(TURK
OF PERMITTEE
WILLIAM J.FOX.Coumw BS1o1N1lit VAIMMM FL A.WOOD, CkJXF TLJso. INSirtCTOR
T - - i Q.9,1� OCT 8