HomeMy Public PortalAbout9604 GIDLEY ST_Sewer__ DEPARTMENT OF QOUNTY ENGU EM
DMSION OF HUIIaDII1G AND SAFETY SEWER—SEWAGE DISPOSAL 1
OOU= OF 1,013 Axc r,ffi PERMIT APPLICATION
WILLIA►f J. FOX, COUNTY EMBIN[ER ADDBUILDINGSSRE
a ��
FOR P CANT FI IN, LOCALITY r
BUILDING NEAREST
ADDRESS OROSS Sr
LOCALITY DISTSERIAL NO. PERMIT N0.
NEAREST A 3 $
CROSS ST.
IVH
OWNER BY Raab far 1904CUOR bATE ISSUED
MAIL
ADDREBB �� Usfi NE OCCUP OY MAP
I
PQ
QTY T'ELM �
CONTRACTOR
CO.IMP.N0. .o
ADDRESS
JOB.M0.
CITY TELNO. V2 TRUNK PESMIT NO.
REGISTRATION N0. COUNTY ROAD PERMIT N0.
LEGAL 447 2- N
DESCRIPTION LOT NO. 6 7 STATE ENCROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
0
SIZE OF LOT N .OF BLDGt. WASTE APPROVAL
Q NOW ON LOT OHARGES
USE OF
BUILDINGS CONNECTION CHARGE FEE
NO. DEEICRIFT'IffWEIF W13RK FEE REIMBURSEMENTF[E
PU-NoBLIOSEWER�NN 1 L" G� RECEIPT NO. DATE BY
HOUiff—SEWERCON NG 0
PRIVATE DISPOSAL SYSTEM I.M
EXCEPTION RECORDED
WORK TO HOUSE SEWER Im
ALTERPAIR EXISITN NO DATE RY
SEWER OR DISPOGAL SYSTEM Im
MME ffN ABADo N ER
AND OR DISPOSAL SYSTEM I.M CONNECTION DATA
815PTIO TANK.aMbAGumff OR
PITS AND/OR DRAINFIELD 2Jt STATION -0EPT}{
P60L-ORYWELL
SPECIAL CONDITIONS ONLY 2.11111 MANHOLE REFERENO
UPPER
PE OF OOMNECTION LfiNGTH FROSIV
�—� CURB Y.L TO PA_OWNERS PERMIT t � I o0
AUTHORIZATION I TOTAL FSE
I HAVE THIS DAT[ OONTGACTEDWITH THE HEREIN NAMED 71
CONTRACTOR TO OONNEOT THE ABOVE DESCRIBED EXISTING APPROVALS INSPEOTOR'SBIGNATURE DATE
DWELLING TO THE PUBLIC SEWER r�
SIGNED THIS ( DAY F 0ecat 19NEW HOUSE SEWERCONECT
OWNER OR BUMLDING OR MADDONAL
OWNERS AGENT
8EPT10 TAM11((,,BEEP.PITO
ADDRESS ASD OR DRAINFIELD
I HEREBY AO-KNOWLEDGE THAN I HAVE R11AD THIS APPLI- CESSPOOL E] DRYWELL I]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIp (EWER OR
pEGULATINB PLUMBING AND SEWERS SDIBOON D EEbT PLUG ANDWAGE L SYSTEM
DIGPOItA
1 HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED
AMD/OR LIOENSED AS REQUIRED BY LOB ANGELES COUNTY
AND STATE OF CALIFORNIA OR THAT 1 AM THE LEGAL OWN-
ABANDON HOUSE SEWER
ER OF THE ABOVE DESCRIBED RESIDENTIAL ROPERTY. BACKFILL SEPTICTANKS
❑❑
SIGNATURE BEEP.PIT(S)� CESSPOOLBF]
OF PERM V�n !7!ts�
7LA642D 6Q3 L/W
DEPARTMENT OF OOUNTY II'QC9NXEB
SEWER-SEWAGE DfSPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
000NTY OF IAB ANGET
WILLIAM J. FOX, COUNTY ENDIIN[[R BUILDING R
ADDRESS
FO APPL1 TOR N LOCALITY
BUILDING NEAREST Jr
ADDRESS CR088 ST.
LOCALITY DISTRICT NO. &ERIAL NO. P YIT M
r
NEAREST A ' S
CROSS 8T.
RECEIVED BY Boa*Tyr IssvegUM ATE IS&drD
OWNER
PAIL
ADDRESS USEZONE OCCUPANCY YAP
SK PQ
CITY TELMO.
CONTRACTOR CO.IMP.N0: )
r
ADDRESS
JOEL N0.
OITY ELM 74 TRUNK PERMIT NO.
REGISTRATION NO. ROAD PERMIT NO.
LEGAL /0 STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT N0.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT b .Q�C� N0.OF BLDCS
16 NOW ON LOT ARLES
USE OF
BUILDINGS OONNECTION CHARGE FEE
N0. DESCRIPTION OF WORK FEE BEIMBU6EMENTFEE
HOUSESEWER 001INECTIPHI
PUBLIO8EW[R ! IL6i RECEIPT NO. DA BY
HOUSE SEWER CONNECTINA Iro
PRIVATE DISPOSAL SYSTEM IAS
CONNECT 1 N BL G.0 l EXCEPTION RE ED
WORK TO HOUSE SEWER I.SS O U
A LT t R OR REP A IR EX 1ST N M0' E BY
SEWER OR DISPOSAL SYSTEM IAS
DISCONNECT AND ABANDON SEW R
AMD OR DISPOSAL SYSTEM 1.04 CON ON DATA
PTJ TANK,SEEPA P1 OR
PITS AND/OR DRAI
NFIELD L00 STATION DEPTH
CESSPOOL-DRYWELL
SPECIAL CONDITIONS ONLY 2.00 ANHOLE REFERENCE
UPPER LOWER
TYPE OF CONNEPTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L
OWNERS �rT $ 1 00
AUTHORIZATION I TOTAL Frf D
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE BLIO SEWER
SIGNED THIS Y OF 190 MEW HOUSE&EWER
OWNER OR CONNECT ADDITIONAL
OWNER& AGENT BUILDING OR WORK
SEPTIO TAM11((,,SEEP.PIT(8)
ADDRESS AND/OR DRAINI,IELD
1 HEREBY ACKNOWLEDGE THAT IKHAVE RlApeTHIS APPLJ- CE&STOOL E] DRYW[LL❑
CATION AND STATE THALLAT THE ABOVE IS COR CT AND AGREE
TO COMPLY REGULATING PLUYBINO AND SEWERS.
ND &TAT[ LJ1Wi ALTER,SEPAIF%I WER OR
I HEREBY CERTIFY THAT 1 AN PSOPERLY REGISTERED bEW E DII& SYST
rM
AMD/OR LICENSED AS REQUIRED BY LOS ANGELES DOUNTY DISCONNECT PLUG AND
AND STATE OF CALIFO NIA ON THAT I AY THE LEGAL OWN- ABANDON HOUSEiiWER
ER OF THE ABOVE IB[D RESIDENTIAL PROPERTY. BAOKFILLn
SIGNATURE
6[EP.PIT(S) QEiiPOOLi
OF PERMITT
TU/41D 6Q>! /W