HomeMy Public PortalAbout9610 GIDLEY ST_Sewer__ 7elk:42o —cEeoe -1e-n. APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING O /
ADDRESS I LOCALITYNEARESTFOR APPLICANT TO FILL IN CROSS ST.LEGAL
DESCRIPTION LOTNO. OWNERMAILBLOCK TRACT ADDRESSNO. OF BLDGS.SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF DISTRICT N0. CROUP MAP pR0 SSED
BUILDINGS BK fPS
CONTRACTOR S l
ADDRESS y�. �y ,� CONNECTION DATA
CITY ' TEL. NO. -'V 4^/ r STATION DEPTH
STATE y w� p� LIC MANHOLE REFERENCE ER
LICENSE NO, is ! GLASS LOWER
NO. DESCRIPTION OF WORK FEE CONNECTION LENGTH FRO
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P.
PUBLIC SEWER @ $7.00
P.C.
SEPTIC TANK.SEEPAGE PIT OR NO.
CO.IMP. JOB
PITS AND/OR DRAINFIELD @ $10.00 N
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HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. R D PERMIT NO. 0_
PRIVATE DISPOSAL SYSTEM @ $3.00 O
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT *,,IV,. EAS1:N[Ni CORD.' TR.NO. DATE u
WORK TO HOUSE SEWER @ $3.00
OVERFLOW SEEPAGE PIT.DRAINFIELD w
EXTN..CESSPOOL.DRYWELL. $5.00 O
�R!"TG71:R[T}RR'V'R ABANDON HOUSE
HWY.OR ST.WIDEN. V
SEWER ZFF%iri ^ V rF4 $3.00 STATE ENCROACH NT
Lu
MANHOLE $7.00 PERMIT NO. N
INDUSTRIAL Z
WASTE AP VAL
OWNERS PERMIT s 3 00 CHARGES
AUTHORIZATION I TOTAL FEE is CONNECTION CHARGE FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF 19_
OWNER ORNEW HOUSE SEWER
OWNERS AGENT
CONNECT ADDITIONAL
ADDRESS V�.7� • afI��' BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT THEABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ❑
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR.SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT i AM THE LEGAL OWNER OF. D INTEND TO DISCONNECT PLUG AND
RESIDE IN. THE AB E DESCRIBED RES DEN IAL OPE RT Y. ABANDON HOUSE SEWER
SIGNATURE BACKFILL SEPTIC TANKS ClOF PERMITTEE (�(/V� c - SEEP.PITIS) SPOOLS ❑
VALIDATION CK. M.O. CASH
U-jw 7 0 4 4- SEP 1 1 0 D e .0 ON a
^ T
APPLICATION FOR PERMIT 1
DIVISIO�lyOF� �
BUIWI NG AND
SAFETY SEWER-SEWAGE DISPOSAL
Comity of Los Atealm BUILDInG /T `
JOHN A. LAMBIE,CouNTY ENGINEER ADDIlSS (J
m C.AA"T#D.GRIFFIN, HUP'T OF BUILDING LOCALM
FOR CANT TO FILL IN CCRRO QST.
LEGAL
DESCRIPTION LOT OTNMR
Cl MAIL
BLOCK TRACT ADDRM
0.OF BLD Ga, CITY TEL 110.
SIZE OF LOT OW ON LOT
U"OF
1TICN0. GROUP_
BK PG
CONTRACTOR
ADDRESSpu
NNEcnON DATA
�{ ST
n&(f DEPTH
CITY NO'. t MA11H RSFEIIFIICE UPPER
ATE LOWER
REGISTRATION N0. 19 ❑ COUNTY r
No. DESCRIPTION OIF WORK FEE TYPE OF CONNECTION LENGTH FROM ,
HOUSE SE7ER CONNECTING O Y. CURB P.L. M. L.
PUBLIC 8 ER 3.30 IS
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAIXFIELD 5.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO. -
EXTN.,CEJSSPOOL DRYWELL MANHOLE 10 ;2.00 CO. IMP. NO. 6p, JOB NO.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00 TRUNK PERMIT X0. ROAD PIRMIT NO. 57
CONNECT ADDITIONAL BLDG.OR STATE ENCROACH XT
WORK TO HOUSE BEWER ;1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEIVER OR DISP09AL SYSTEM 1.00 WASTE APPROVAL O
CHgR9ES
CONNECTION CHARGE FEE -
OWNER'3 PEI3IcT $ 1 00
AUTHORIZATION TOTAL FEE � REIMBURSEMENT-FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN X ED CON- APPROVALS DATE IXSP QR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEVER
SIGNED THI Y OF 19 CONNECT ADDITIONAL
OWNER ORBUILDING OR WORK
OWNERS AGENT 1,` -° SEPTIC TANK,SEEP-PIT(S)
ADD AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION C" POOL❑ 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 SYJTE M
IHEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/QR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEPACKFILL$EFTIC TANKS❑
SIGNATURE 'x") SEEP.PIT S) ❑ CESSPOo
OF PERMITTEE
JOHN A. LAMBIE,COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIS:F PLBG. INSPECTOR
al. M.0. CK"
tib 4 4.5 G
J J-.
6"
a
9 I APPLICATION FOR PERMIT 1
4eDVIMQN'OF BUILDING AMID SAFE'T'Y SEWER—SEWAGE DISPOSAL
D"-rftn. of C--t7 F-gfn~
C=mt7 of Los Anw9es BUILDING
JOHN A. LAMBIE. CouNTY ENGINEER ADDRESS
m CABEATT D. GRIFFIN, SUP-T OF]BUILDING LOCALITY
FOR WLICAM TO FILL IN CROSS ST.
LEGALell
OWNER
DEZCRIPTIOII L
MAIL
BLOCK TRACT ADDRF59
NO. OF BLDGS. CITY TEL. N0.
SIZE OF LOT NOW ON LOT
USEOBUILDINGS DDISTRICT N0. GROUP K MAP
BUILDINGS � G
CONTRACTOR
ADDRESS ON DATA
STATIOX DEPTH
CITY NO. ! (./ NAY H0 LE REFERENCE UPPER'
LOWER
REGISTRATION N0. f C g ❑ COUNTI'
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF COX ECTIOS LENGTH FROM
Y. CURBBP.L. Y.L.TO P.L.
PUBLIC SEVER 3.50 ,
SEPTIC TA11K,SEEPAGE PIT OR
Pl AND/OR DRAINFIELD 3.043-
OVERFLOW
.00OVERFLOW SEEPAGE PIT,DRAINFIELDP. C. NO.
I
EYTN.,CESSPOOL DRYWELL MANN LE S 2.00 Co. IYP.-110. JOB N0. '
I HOUSE SEfB1t CONNECTING TO
Y PRIVATE DISPOSAL SYSTEM s 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE EXCROACHMENT
110RR TO OUSE SEWER Q 1.00 PERMIT NO.
ALTER,REPAIR R ABANDON HOUSE INDU/TRIAi. `
SEWER OR DISPOSAL SYSTEM I.00 rAg'I=APPROVAL
CHARGES
S O CONNECTION CHARGE In
OWNEE'S PEH1tilIIT $
A=OEIZATION I TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THISDATE A CONTRACT WITH THE HEREUX HAYED CON- AMOVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED_MISTING pffEL ING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNFD THl Y OF 19 CONNECT ADDITIONAL
OWxER OR BUILDING OR WORK
OWNERS AGENT SEPTICTAIIK,SEFPI PIT(5)
ADDRES AR /OR DRAIXFIELD
1 HEREBY ACKNOWLEDG THAT 1 HAVE READ THIS APPLICATION CE331-OOLP DRYWElI❑
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 I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT 1 AN T E LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDE AL PROP BEEP FII4 SEM CTBAA Poo❑ ❑
SIGNATURE T
OF PERMITTEE
JOHN A. LAMBIE. CouNTY ENGINEaR VALIDATION ROBERT A.WOOD, CHIMF P4B0. INSPECTOR
�';,�0 2 4 ,^JL 6 5 5,0 0 In