HomeMy Public PortalAbout9410 GIDLEY ST_Sewer__rT
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8& - APPLICATION FOR PERMIT
469 IV••DISION OF BUILDING AND SAFE7Y SEWER-SEWAGE DISPOSAL 1
D.psatm.at of Co-t7 E2ahum
C mt7 of 1-a Anuo]" eUILDIXG _
JOHN A. LAMME, COUNTY ENGINEER ADDRElS (r
m C.ADBATT a.GRI"IN, BWr'T of BUILDING LOCALITY
FOR APPLICANT TO FILL IN " �
LILGAL .
DESCRIPTION LOT N0. OWNER
PAIL
BLOCK TRACT 2 ADDRESS
NO. OF BLDGSI. CITY TEL N0.
SIZE 0 LOT XOt ON LOT
UU$fil LDOF
BU AP DISTRICT N0. OR06UP YINGS
B[ PG _
CONTRACTOR Iff � h
ADDRESS d CONNECTION DATA
f
STATION DEPTH
CITY TEL. NO. I
WIHOLE RkFERH1XCE T UPPER
ATE
REGISTRATION NO. 0 COUNTY a
No. I DESCRIPTION OF FEE
HOUSE SEWER CONNECTING TO H OF CONNECTION - LENGTH FROM 1
PUBLIC SEWER B S 3.50 CURB P.L. ■.L.TO P.L
SEPTIC TAXI ,SEEPAGE FIT OR
PITS AND/0 DXIAIXFIELD Q 3.00
OYEtFLO SEEPAGE PIT,DRAINFIHLD Co. INP. N0. JOB N0O
EXTX.,CESSPOOL DRYWELL MANHOLE 2.00
i HOUSE SEVER CONNECTING TO
1 PRIVATE DISPOSAL STBTEY $1.00 TRUNK PERMIT NO. ROAD PKRM17 O
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q s 1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q 41.00 WASTE APPROVAL -
CHARGES
GOXNECTIOX CHARGE FEE _
OWNER'S Mum $ 1 00
AUMOHI7.ATION TOTAL FEE REIrsuRSEYEIIT FEE ;
,
I HAVE AT THIS DATE A CONTRACT WITH THE HERSIN NYED COX- APPROVALS DATE IN$ ECTOR'SSI-GNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SE-WER. NEW HOUSE SEWER Y�
SIGNED THIS SAY OF 19CONNECT ADDITIONAL
OWNEROR BUILDING OR WORK M U
OWNERS AGENT ///��,� SEPTIC TANK,SEEP,PIT(S)
ADDRES 'AXD/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE AB VE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDI AXCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUGHOUSE 3 AND
LICENSED AS REpU1RED Y LOS ANGELES COUNTY AND STATE OP ABANDON CT PLUG AND
CALIFORNIA OR THAT AY THE L AL OWNER F THE ABOVE
WER
DESCRIBED RESIDENTIA PROPERTY. BACKFILLS IC TAMS Q
SIGNATURE SEEP.PIT(S) CESSPOOLS❑
OF FERMITTF.E
JOHN A. LAMB CouN ENGINE �„}/ALMATION ROBERT A.WOOS, CHIS PLBG. INIiPECTOR
C/SK)
M.0. CASH
1 , 7 9 8 3 4 1",Y 4 7.5{� �'