HomeMy Public PortalAbout9408 GIDLEY ST_Sewer__ D
CES08 if-57 APPLICATION FOR PERMIT 1
E80B
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /'
JOHN A. LAMBIE. County Engineer ADDRESS
CASSATT D. GRIFFIN, Sup t of Building LOCALITY
FOR APPLICANT TO IN
NEAREST.
LEGAL -03 IPOI
DESCRIPTION LOT NO. OWNER
BLOCK MAIL 74
mu ADDRESS
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT CITY TEL.NO.
USE OF
BUILDINGS DISTRICT NO. GROUP I MAP
CONTRACTOR / BK P6
ADDRESS CONNECTION DATA
CITY TEL.N0. STATION DEPTH
ATE MANHOLE REFER CE UPPER
REGISTRATION NO. O 0COUNTY jLOWER
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO 40
PUBLIC SEWER °e $3•
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION LENGTH FROM PITS AND/OR DRAINFIELD @ $3.00 Y. CURB P.L. M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MAN HOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C.N
PRIVATE DISPOSAL SYSTEM @ $1.00 CO. IMP.NO. JO
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT N0. ROAD PERMIT N0.
ALTER, REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHME
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
if CHARG
OWNERS PERMIT $ OO CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE 7 V REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER _
OWNER OR CONNECT ADDITIONAL -
OWNERS AGENT BUILDING OR WORK `"
ADDRESS SEPTIC TANK,SEEP,PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED A LOS ANGELE COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT M T LEG OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDE RO BACKFILL SEPTIC TANKS El
SIGNATURE SEEP.PIT(S) [--] CESSPOOLS EI
OF PERMITTEE
Or LI ROBERT A. WOOD
CK. H..0.O. CASH SUPERVISING MECHANICAL ENGINEER
'402770M rE3251 A 3.00