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Home My Public Portal About9518 GIDLEY ST_Sewer__ s _ -�i2- 76A642D APPLICATION FOR PERMIT 6A642 COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICANT TO FILL IN CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER Zg MAIL BLOCK TRACT ADDRESS NO. OF BLOGS. SIZE OF LOT NO LO CITY i TEL. N USE OF BUILDINGS DISTRICT NO. GROUP MAP PROCESS .BY BK a l CONTRACTOR ADDRESS ' /JI CONNECTION DATA CITY �/ TEL. NO. STATION 1-3 DEPTH 60 AT REGISTRATION NO. STATE COUNTY MANHOLE REFERENCE L11, i3 l LOWER NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FR HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 SEPTIC TANK,SEEPAGE PIT OR P.C.NO. PITS AND/OR DRAINFIELD @ SIO.00 CO.IMP.NO. JOB NO. HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. �. PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWER @ $3.00 AFFIDAVIT I WAIVER EASEM[NT RECORD. INSTR.NO. DlkTEf OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 ALTER.REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM Q 53.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL �� + WASTE APPROVAL OWNERS PERMIT S 2 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED ISTING DWELLING TO THE PUBLIC SE E . APPROVALS DATE INSPECTOR'S SIIrNAiTURE SIGNED THIS DAY OF (g" OWNER OR OWNERS AGEN NEW HOUSE SEWER ' CONNECTADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT` HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑ PLUMBING AND SEWERS. :,� ...... CESSPOOL ❑ DRYWELL I HEREBY CERTIFY TH .1' AM PRO RLY E ISTERED D/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRE BY LOS ANG ES CO N Y AND STATE OF SEWAGE DISPOSAL SYSTEM - CALIFORNIA OR THAT I THE LEGA OWIy O AND I TEND TO DISCONNECT PLUG AND RESIDE IN. T ABOV SCRIBED R SIDE PROP ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS OF PERMITTEE ��/� ❑ SEEP.PIT IS) ❑ CESSPOOLS ❑ q'IO� ROBERT WOOD SUPERVISING MECHANICAL ENGINEER CK. M.O. CASH 642D°.82 76AAPPLICATION FOR P MIT 76 A 842 COUNTY OF LOS ANGELES SEWER—SEWAGE DISP SAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING • JOHN A. LAMBIE, County Ea ia66i ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST FOR APPLICA T9,FII. CR056 Br. _L ' LEGAL DESCRIPTION LOT N OWNER MAIL f BLOCK TRACT � ADDRESS ` t7 NO. OF BLDGS. / TEL. SIZE OF LOT NOW CITY USE OF DISTRICT NO. GROUP MAV PROCESSED BY BUILDINGS BK PG CONTRACTOR 2 ADDRESS ,� C-., C CONNECTION DATA CITY TEL. NO. STATION DEPTH STATE UPPER REGISTRATION NO. D COUNTY MANHOLE REFERENCE LOWER NO. DESCRIPTION OF WORK FEE rTYPE OF CONNECTION LENG OM HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.L. O PUBLIC SEWER @ $5.00 SEPTIC TANK.SEEPAGE PIT OR P.C.NO. V CO.IMP.N . -1OB NO. PITS AND/ DRAINFIELD @ E10.00 GC HOUSE SEWER CONNECTING TO N T PERMIT NO. PRIVATE DISPOSAL SYSTEM $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WIIIYER iASEME&T RECORD.INSTR.NO. DATE) l�J WORK TO HOUSE SEWER @ $3.00 ./ f1 OVERFLOW SEEPAGE PIT,DRAINFIELD h EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $5.00 Z ALTER,REPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT I PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT s 2 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION 2-R-.FEE I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMEDCON- REIMBURSEMENT FEE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS TO THE PUBLIC SEWER. DATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LA REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CERTIF HAT I AM P L REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS RE ED BY LO ANGL OUNTY NO STA OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR I AM TH LEGA O ER OF INT D TO DISCONNECT PLUG AND RESIDE I TH OVE DESCR BED ENTIA ERT ABANDON HOUSE SEWER SIGNATElOF P E BACKFILL SEPTIC TANKS SEEP,PIT(S) ❑ CESSPOOLS ❑ T1 � ROBERT WOOD SUPERVISING MECHANICAL ENGINEER M.O. CASH 1