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Home My Public Portal About9609 GIDLEY ST_Sewer__ ;;w 11-0a APPLICATION FOR PERMIT DIVISION OF BUMDING AND SAFETY SEWER-SEWAGE D I S POSA L Doporbn mt of C*—ty En hww Co>mt7 of Los Amoolm FkDDREU JOHN A. LAMBIE, COUNTY ENGINEER m CA AATT D. GRIFFIN, 8ur'T of BUILDING .EV FOR APPLICANT TO FILL IN . LEGAL LR DESCRIPTION LOT NO. MNA BLOCK TRACT AILL r ADDRESS M0. OF BLDG CITY SIZE OF LOT XOW ON LOT �) TSL. X0. USE OF BUILDINGS DISTRICT NO. GROUP MAP BE PG CONTRACTOR z T 14 971/ - ADDRESS 2 SCONNWMW �` N DATA STATION5�-60gDEPTH CIT1f ,` 01.6 TEL N S S MANHOLE REFERENCI _ UPPER REGISTRATION NO. r OLOWERLOWERUNTT No. DF-SCRIPTION OF WORK FEE HOUSE SEWER COKKEclrimQ TO TYPE OF CONNECTION 'LENGTH FROM PUBLIC SEVP4 9,60 Y. CURB P.L. I.L.TO P.1— SEPTIC .LSEPTIC TAkK.SEEPAGE PIT OR - PITS AHD/OR DRAINFIELD S 3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. N0. EZTN.,CESSPOOL DRYWELL MANHOLE .00 CO. IMP. N0. JOB NO. HOUSE SEWER CONNECTING TO PRIVATEDISPbSAL SYSTEM ® 1.00 TRUNK PERMIT NO. - AD PERMIT N0. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL EWER OR DISPOSAL SYSTEM 11.00 WABTE APPROVAL- CHARGES CONNECTION CHARGE FEE OVPNERls PST i 1 00 AUTHORIZATION TOTAL FEE J REIISURSEMENT FEE' 1 HAVE AT THIa DATE A CONTRACT WITH THE HEREIN RAYED COX- APPROVAT•S DATE INSPECTOR'SSIGXATURE TRACTOR TO CONNECT THE A3QVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER SIGNED THIS SAY OF 19 CONNECT ADDITIONAL OWNER Oq BUILDING OR WORK OWNERS AGENT pig( SEPTIC TANK,SEEP,PIT($) ADDRESS AMD/OR DRAIXFIELD I HEREBY'ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CEEgp00L❑ 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 STEM I HEREBY CERTIFY THAT I AY PROPERLY R GISTERED AND/OR DISCONNECT PLUG AND LICENSED AE REQUIRED BY 3 ANGELS$ C AND STATE OF .ABANDON ROUSSE EAS CALIFORNIA OR THAT I A THE LEGAL QF THE ABOVE DESCRIBED RESIDENTIAL PERTY. BACKFILL SEPTIC TANS❑ SIGNATURE SEEP.PIT($) ❑ CESSPOOLS❑ OF PERMITTER mom JOHN A. LAMBIE, C TY ENGINEER jALMATION ROBERT A,WOOD, CHIEF—F a. INSPECTOR I CASH 1 8 3 5 N mAR 4 4 A 2.0 0 � APPLICATION FOR PERMIT 1 •r 4eea tf�p DrMON OF BUIMING AND SAFETY SEWER—SEWAGE DISPOSAL D"-ftmmt of Cott EnOmw . C -tp of L* Anger F.77 JOHN A. LAMBIE.CoUNT'Y ENa1NEKA CA98ATT D.GRIFFIN, SUF'T OF BUILDING FOR APPLICANT TO FILL IN LEGAL DDM DESCRIPTION LOT N0. -57 MAIL ZAVAWA BLOCK TRACT ADDRESS NO.OF BLDG1. SIZE OF LOT XOR ON LOT CITY l(z �/ TEL. NO. USE OF • DISTRJCT GROU ■AP BUILDINGS g[ PG CONTRACTOR V • ,1 '/` ADDRESS e co>!aC=011 Dara T STATION 0 DEPTH CITY TEL YO. f� YANHOLB RfiFYRIilICII C•y+2 �dj'��Z ❑ STATE 9 -raw REGISTRATION NO. ❑ COUNTY so. 1 DESCRIPTION Of WORK FEE HOUSE SEWER CONNECTING TO TYPE OF ON LENGTH FROM d PUBLIC SKWER 3.50 URB ■.L.TO P.L. SEPTIC TANK,SEEPAGE P T OR PITS AND/OR DRAINFIELD 5.00 OVERFLOW SEEPAGE PIT,DRAINF1ELDP. C. NO. i EXTH.,CfiSSPOOL DRYWELL MANHOLE 2.00 CO. IMF. N0. JOB N0.' HOUSE SkVER CONNECTING TO . i PRIVATE DISPOSAL BYSTEN S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO. CONNECT ADDITIONAL BLDG.OR WORK TO HOUSE SEWR IV H $1.00 IF NOOROACHMENT t, ALTER,REPAIR OR ABANDON HOUSE INDUSTRIALSEWER OR DISPOSAL SYSTEM 41.00 4,. WASTE APPROVAL CHARGES ; CONNECTION CHARGE F1<-H' _ OWNER'S PEMW $ 1 00 AUTHORIZATION =O=AT, FU REIMBURSEMENT FEE I HAVE AT THIS DAU A CONTRACT WITH THE HERRIN NAMED COX- APPROVALS DATE 1NSPECTOR'SSIGMATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING r TO THE PUBLIC SEWER. NE-W MOUSE SEWER P SIGNED THIsDAY OF LJ/ 19 CONNECT ADDITIONAL OWNER OR BUILDING OR YORK OWNERS A EXT - SEPTIC TAlIK,INSEEP,PIT(B) ADDRE9 'D O AND/ORD FIELD 1 HEREBY DBE THAT I HAVE READ THIS APPLICATION AND STATE THHATAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRY-WELL❑ WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY .THAT I. AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND $TATE OF CALIFORNIA OR THAT AY THE LEG L.OWNER OF THE ABOVE ABANDON HOUSE ER A DESCRIBED R- IDENTI P OPER TT. BACKFILL SEPTIC TANKS❑ BIGNATURE 3EEP.PIT(9) ❑ CIA 5P00LS NL OF PERMITTEE j +- JOHN A. LAMBIE, COUNTY ENGINEER VALIDATION„ ROBERT A.WOOD, CHIEF PLE10. INSPECTOR Cz- ■.0. cAs■ jwo 0 4 7 JCA-?? 4 4.5 n �'.