HomeMy Public PortalAbout9526 GIDLEY ST_Sewer__ ;-9'a APPLICATION FOR PERMIT .
DIVISION OF B=ING AND SAFETY S EW E R--S EWAG E D I S POSA L
Dep-t--t of Cona y Enghmm
cc" of Loo AIwoft rAD
LDING
JOHN A. LAMBIE, COUNTY ENGINEER RSNa CASSATT�D.GRITFFIN, BOr-^i or BuiLmmo - rA�
FOR APPLICANT TO FELL IN
LEGAL OTHER
LOT'NO.
MAIL
BI,QCK TRACT �j ADDRESS
0 OF
SIZE OF LOT NOON LOTS
■ "' CITY r TF-L. NO.
USE
ELDFNGS DISTRICT X0. GROUP YAP
JgK PG
CONTRACTOR - /„�
COPUC=ON DATA
ADDRM
CITY TIL. N0. F ��O STATION DEPTH -
MANHOLE R&KRILK PP
REGISTRATION NO. g�TG ❑ COUNTY
o. DESCRIPTION OF WORK FEE
HOUR[86�[ CON C71 GTO 7 TY OF CONNECTION Ld_](QTH FRO■
PUBLIC BBWEIt B 3.b0 7 � T. CURB .L M.L. O P.L
SEPTIC TANK,-SEEPAGE PIT OR
PITS AND/OR D"INFIEL
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C-■0.
i
EXTN.,CESS POO L,DRYWE L MANHOLE ® 2.00 CO. IMP. NO. t/ JOB NO. "
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM (a s 1.00 TRUNK PERMIT N0. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK
TO HOUSE SEWER @ ;1.00 #,f PERMIT NO.
ALTER,R£PAIR QR ABANDON HOUSE
INDUSTRIAL
"SEWER OR DISPOSAL SYSTEM 100 -
WASTE APPROVAL ,
CHARGES
CONNECTION CHARGE FEE
n AUTHORIZATION =pO AAL FU ; 1 yw 00 REIYBURBEYEXT PEEfl
P'n
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN RAYED CON- APPROVALS PATE INS ECTOR'Sa1GNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS SAY OF 19 CONNECT ADDITIONAL
OWNER OR ,�// 7M% BUILDING OR WO K N u
OWNERS AGENT C .,2r.
�- - SEPTIC TANK,SEEP,PIT(S)
ADDR AND/OR DRAINFIEWY
IH
ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AN PROBERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR TWIT I AY THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP. PIT(S) ❑ CESSP00 1
OF PERMITTEE -
JOHN A, LAMBIE. COUNTY ENGINE.r.R VALIDATION ROBERT A. WOOD, CHIEF PL.DG. INHP[C-TOR
CL Y.0. CATHt art
-
6 6 0 :3 E; -MAR 2 9 4 5.5 0