HomeMy Public PortalAbout9582 BISBY ST_Sewer__ APPLICATION FOR PERMIT
a 4�eDIYISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL 1
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JOHN A. LAMBIE,COUNTY ENGINEER ESSCAE:BA=D. GRIFFIN. SUPT OF BUILDING LITY1� FOR APP�11CANT TOS /FILL IN uPv. L ` -
DESCRIPTION LOT NO.W' 'YV �^) • O� OWNER
�`
PAIL
BLOCK TRACT ADDRESS
SIZE OF LOT NOW ON LOTS CITY TEL. X0. '
USE OF
BUILDINGS AP DISTRICT N0. GROUP Y
BK Pa
CONTRACTOR .
ADDRESS CONLMCTION DATA ( .
CIT` F TEL. NO. d 8 '� STATION / DEPTH
MANHOLE REFERENCE r
�`` (�1TATH - ✓ LOWER
REGISTRATION NO. 10 �V ❑ COUNTY
No. I DESCRIPTION.OF WORK FEE(
HOUSE SEVER CONNECTING TO YTYPE OF ION W.L.LENTO P.L.
PUBLIC SEWER @ 4 9.50
SEPTIC TAMKI SEEP GE PIT OR
PMTS AMD/OR DRAIX�IELD 9.00
OVERFLOW SEEPAGE PIT,DRAIXFIELD P• C. NO.
i
EXTX.,CE"P00 D- I YAXHOLE 2.00 CO. IVP.M0, JOB NO.
i HOUSE SEWER CONNECTING TO J O a
-71
1 PRIVATE D4SPOSAL SYSTEM ® 1.00 TRUNK PERMIT NO. ROAD PERMIT N0. F
COXNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER @ f 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE "
INDUSTRIAL
SEWER OR DISP95AL SYSTEM @ 11.00
WASTE APPROVAL ,
CHARGES
CONNECTION CHARGE(FEE
OWNEg'S PERMIT $ 1 00
AUTHORIZATION TOTAL. FSE REIMBURSEMENT FEE
I HAVE At THIS DATE A CQXTTRR-ACT WITH THE HEREIN HAYED CON- AMOYAIS DATE 1 ECTO 'SSIGXATURE
TRACTOR TO CONNECT THE ABOVG DESCRIBED EIISTING DWELLING
TO THE PUBLIC SEW NEW HOUSE SEWER
l
SIGNED THI AY�OF r.11CONNECT ADDITIONAL
OWN OR UILDI G OR WORK
OWNERS AG 9EFT ICTAA K,SEEP,PIT(S)
ADDRFS AMD/OR DRAINFIELD
I HEREB ACJC11 D 1 HAD THIS APPLICATION CESSPOOLO DRYWELL❑
AMD STATE THAT THE ABOVE IS CORSE'VA AGREE TO COMPLY
WITH ALL COUNTY ORDINANCE.
AND ATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND Zk VER5. SEWAGE-DISI-OSAL SYSTEM -
I. HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PL G AMD
LICENSED AS REQUIRED BY LOS ANGELES. COUNTY AND STATE OF ABANDON HOUn
CALIFORNIA OR THAT I AN THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAA PROP TY. BACKFILL SEP"[IC TA)IKS[ISIGNATURE SEEP.PIT(S) a SS
CEPOOLS l
OP PHRYI'r.1
JOHN A- LAMBIE,COUNTY ENGINEER AlIDATION ROBERT A.WOOD,CHIR7 PLBG. INHPICTOR
Ill.0 CARS
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