HomeMy Public PortalAbout9621 GIDLEY ST_Sewer__ _._.i .
70A E420-CESOS-10-71 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
DUILDING AND SAFETY DIVISION OU
ILDI No r /�
ADDRESS
LOCALITY Z
NEAREST
FOR APPLICANT TO FILL IN CRS ■T' 77iomLEGALt
DESCRIPTION LOT NO. OWNER
HAIL
BLOCK TRACT ADDRESS CJ /
NO. OF BLDGS.
BIZ[ OF LOT NOW OH LOT CITY TEL. NO.
USE OF DISTRICT N0. ■ROUP 14AP FRO E■■ED BY
BUILDINGS BK PS
QONTRACTOR
ADDREI■ ,Qp! CO ON DATA
CITY G`/T TEL• IN B 2`j STATION p� - O
STAIN LIC � 2 j E R[FEA[NC[
LICENSE NO. ZZ YMANHOL
/ 7
No. -DESCRIFT ON OF WORK FEE TYPE OF cGl�� ION LENGTH FROM
HOUSE SEWER CONNECTING TO Y. F.L. Y.L.TO F.L
PUBLIC SEWER 0 $7.00
■ IC .■EEPAG[FIT OR C.
N4.
ITS AND/OR DRAINFI[LD 510.00
CO.IMF.NO. J NO.
HOUSE SEWER CONNECTING TO TRUNK PER4rr NO. ROAD MIT NO.
PRIVATE DISPOSAL SYSTEM 57.00 O
CONNECT ADDITIONAL nLDd.6h AFFIDAVIT •AIv[a I-Wrn[R JIECORD.INSTR. DAT[ U
WORK TO HOUSE SEWER X3.00
OVERFLOW SEEPAGE PIT.DRAINFI[LD
[XT N_C[SJr OO L D RYW LLL 0 $5.00 O
R. A N O KWY.OR ST.WIDENING F
•[W3.00 5.00 FIAT[ENCROACHMENT [y,
MANHO ! $7.00 PERMIT NO, a
INDUSTRIAL h
��������++pp��p WASTE APPROVAL Z
OnJ.\�.^s PERMT j S 00. CHARGES
CONNECTION CHARGE►IE
AIITHOHTLATION Tofu, FEE
I HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NAMID CON- R[IMSURS[M[HT FE[
TRACTOR TO CONNECT THE ASOV[ DESCRIBED [xIBTING DW[LLINO
TO THE PU-BLIC S]rWER. AMOVAIS DATE INSPECTOR'■SIGNATURE
SIGNED THIS DAY OF tO_
OWNER OR NEW HOUSE S[W[R
OWNERS AGENT '7-7CONNECT ADDITIONAL
ADDAEI o � �, BUILDING OR WORK
SEPTIC TANK.SEEP.PIT{q
1 HEREEY ACKHOVVLKDGK THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND STATE THAT TH[ ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEW[RS. CEYf POOL Q DRYrTLL ❑
I HEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR
LICENSED Al R[QUIR[D SY LOS ANGLES COUNTY AHD STATE OF SEWAGE DISPO■.AL SYSTEM
CALIFORNIA OR TH��Ij'[ OWNER O , AND INTEND TO DISCONNECT PLUG AND
RUIDS IN, THE ABUID PROPERTY. ABANDON HOUSE SEWERRESISIOE R[ BACKFILL
OF PERMfrfRE
49
ou
tA 1-30
VALIDATION4
.0. CASH
CK.
436A .10 .0 6.00 •: