HomeMy Public PortalAbout9409 GIDLEY ST_Sewer__ 7M641D APPLICATION FOR PERMIT. 1
Ai400DIIVIMON OF BUILDING
�AND SA.FEfY SEWER—SEWAGE DISPOSAL
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of v"++'Z Enubmw
C =mtp of Lm An"les F.ADDRESS
DING
JOHN A. LAMBIE,COUNTY ENGINEER
m CA89ATT D. GRIFFIN, 8ur•T o�BuiLDine LITY
FOB. APPLICANT TO FILL IN R SSIT.
LEGAL OWNER
DESCR SCION LOT N0.
BLOC 1AIL TRACT q ADDRFS! .
NO.OF BLDGS.
SIZE OF LOT NOW ON LOT airy TEL NO.
USH OF DISTRICT NO. GROUP MAP
BUILDINGS
BK PG _
CONTRACTOR 04 12
CONNECTION DATA
ADDRESS
CITY TEL.No.
sTArlox � S 4 -7.
MANHOLE REFERENCE PPER
STATE
REGISTRATION N0. COUNTY
No. DF-SCRIFFTFON OF WORK PEE
HOUSE SEWER CONNECTING TO TYPE OF RB ION VL. TH FROM
PUBLIC SEWER � f 3,50 Y. P.L. 11 L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD f 3.00
OVIERFLOW SEEPAGE PIT,DRAINFIELDR. C. NO.
I
EZTN.,CESSPOOL DRYWELL MANHOLE 2.00 CO. imp. N0. JOB N0.
HOUSE SEWER CONNECTING TO So
PRIVATE DISPOSAL SYSTEM .® f 1.00 TRUNK PERMIT NO. ROAD PERMIT No.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER 8 f 1.00 ERMiT NO.
ALTER,REPAIR OR ABANWN HOUSE
SEWER OR DISPOSAL SYSTEM 1.00 INDUSTRIAL
WASTE APPROY L
,.� CHARGES
' CONNE CHARGE FEH '
ovnm,S PEUM s 1 . o
AIITSOBTLATTON TOTAL. M REIMBURSEMENT Tu .
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN KAA C'6x= APPROVALS DATE IN ECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED STIN
TO THE PUBLIC SEWER. NEW HOUSE SERER Z�
SIGNED THIS AY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK K
OWNERS AGENT of SEPTICTAXK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIfLD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE TAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING rNO SEWERS. SEWAGE-DISPOSAL SYSTEM
1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DIICONNECTPLUGAXD
LICENSED AS REQUIRED BY LOS AN-GELES COUNTY AND STATE OF ABANDON HOUSE SEW
CALIFORNIA OR THAT I THE LEG OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PER T7 BACKFILL SEPTIC TAX"❑
SIGNATURE SEEP.FIT(E) [:1CESSP00 ❑
OF PERMn7a
JOHN A. LAMX COUNTY ENGINEER VALIDATION ROBERT A.WOOD. gHIXF PLEIG. INSPECTOR
ct ■.o. cx"
X07 :3 8 1 APR 2 2 4 4.5 0
LA�07 3 8 2E-, APR22 4 1 .0 0 .