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Home My Public Portal About9627 GIDLEY ST_Sewer__ P ja�� &1� 76A 8420 CE101-10-71 APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING ADDR[Sl C LOCALITY FOR APPLICANT TO FILL IN C o%�T I LKGAL DESCRIPTION LOT NO. OWNER Po MAIL J / BLOCK TRACT ADDRW b NO. OF BLD 5. ■= OF LOT HOW ON LOT CITY TEL. NO. USE OF DISTRICT NO. GROUP /K MAP PRO SEED ■Y BUILDING■ PS CONTRACTOR �� -;t,- ADDRESS CONNECTION D Ti. /T p trT R G ITY -rEL_ N o. .�.8-�—y.3 3 S2AT[ LIC MANHOLE R[P C[ PrimLICKNBE NO, SASS LOWER No. I DESCRIPTION OF WORK FE[ TYPE 011CONN[cr LIE NGTH FROM HOUE•[WLR CONNECTING T Y. CURE ![.L.TO P.L PUBLIC/EWER • $7.00 e FTIC TANK.a EP a[FIT OR P.c.No. PITS AND/OR DRAINFIELD • [10.00 CO.IMP.NO. OB NO. HOUR[SEWER CONNECTING TO TRUNK PERMf7 NO. ROAD NO. PRIVATE DISPOSAL SYSTEM • $7.00 O CONNECT ADDITIONAL .OR AFFIDAVIT •Al�[t "u0-[R[E'f RECORD.I DATE uWORK 70 H04SE aEW[R • $S.00 OVERFLOW/[[PAG[PIT.DRAINFI[LD OC [KT PC-C ESfPOOL.D Ry W ELL • 9E.00 1{ O guoucaR A H U [ � WY.04R RE •WIDN INO BE • $3.00 STATE ENCROACHMENT MANHOLE • 1x7.00 PERMIT NO. d INDUSTRIAL H WART[APPROVAL Z OwN>rx•s PERMT s , 0o- CHA Rd[S CONNECTION CHARGE FEE AUTHORIZATION TOTAI, FEE O I HAVE AT THISDAT[ A CONTRACT WITH 7149 HEREIN NAMED CON- R[IMSURSEM[ T NFEE TRACTOR TO CONNECT THS ABOVE DESCRIBED KXIETINO DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSP[CfOR'f SIGNATURE SIGNED THIS DAY OF 10_ OWNER OR NEW HOUSE fl'1A'[R OWNER/AG[HT CONNECT ADDITIONAL ADDRESS ■U ILDINO OR WORK 1111.11C TANK. PIT(S). I HERE>.Y ACKNow L[DGE [ THAT 1 HAVE RAD THIS APPLICATION AN NDD/OOR 9RA1NFIELF1[LD AND !TATE THAT THE ABOVE I■ CORRECT AHD AOR[[ TO COW FLY WITH ALL COUNTY 7Y [f AND BTATL LAW■ REGULATING n PLUMBING AND /EWERS. CESSPOOL ❑ DRYWELL 4 HEREBY CERTIFY THAT I AM PROPERLY REGIST[R[D AND/OR ALTER.REPAIR.f[W[A OR LICENSED AS REQUIRED ■Y LOB ANGLES COUNTY NO TEAT[ [WAa[DISPOE OF ■ SAL SYSTM CALIFORNIA OR THAT E I AM THE LEGAL OWNER OF NO INTEND TO DISCONNECT PLUG AND REST D[ IN. THE ABOVE DESCRIBED ID TIA ROPO ERTY. ABANDON HOUSE S[WI[R SIONATUR[ BACKF{LL■[fflC TANKI ❑ OF PLR MT7T[[ SEEP.PIT(S) CWPOOLS VALIDATION CK. M.O. CADH 7 0 46A i 4 -D 6.00- 4 1 3aX-faD - APPLICATION FOR PERMIT 1 s 4DrimON OF BUILDING AND SAFEYY SEWER—SEWAGE DISPOSAL Dfpatnnnt of C--ty Enonow County of Los Angel" BUILDING JOHN A. LAMBtE, COUNTY ENGINEER ADDRESS m CASSA"IT D.GRIFFLN, SUET of BUILDIHa LOCAri LA LI FOR APPLICANT TO FELL IN CRp� LEGALyr OWNER DESCRIPTION LO NO. MAIL BLOCK TRACT ADDRESS 0 BLD&!. CITY / TEL X � - �a 91ZH OF LOT NOW ON LOT USE OF / DISTRICT NO GROUP MAP BUILDINGS /g CONTRACTOR v,y yam.✓- 3,- L ADDRESS CONNECTION DATA CITY TML. NO. r„(.' � STATION DEPTH ! MANHOLE REF EREAC EPER /y p ❑ STATE 040-57 REGISTRATION NO. ❑ COUNTY No. DESCRIPTION OF W RK FE HOUSE SEWER CONNECTING TOTYPE OF CU Y.L.CTIO LENGTO P.LTH PROM PUBLIC SEWER B i 3,50 Air SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD 5.00 OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. X0. ' I ETM.,CESSPQOL,DRYWELL MANHOLE j 2.00 CO,IMP. No. JOB NO. I HOUSE SEWER CONNECTING TO PRIVATE DISPOSAL SYSTEM @ j 1.00 TRUNK PERMIT NO. ROAD PERMIT X0. CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEWER @ 1.00 PERMIT NO. - .ALTER,REPAIR OR ABANDON HOUSE (NDUSTRIAL SEWER OR DISPOSAL SYSTEM ® 1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT s g j AUTHOEIZATION TOTAL FEE REIYBURSEYENT FE1tT Q I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COX- APPROVA S. DATE IXSP OR'SSIGNATURE TRACTOR TO CONNECT THS ABOVE DESCRIBED EIISTING DWELLrMG TO THE PUBLIC SEWER. Fitw HOUSE SEWER SIGNED THI AY OF 19 CONNECT ADDITIONAL ppwEpp - BUILDING OR WORK - OWNERS 0 :- SEPTIC TANK,RESP,PIT(2) ADDRES 6 AND/OR DHAIXFIELD -- 1 HEREBY ACKNOWLEDGE THAT HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑ AND STATE THAT THE ASOYE 18 RRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR PLUMBING AND SEWERS. SEWAGE DISPOSAL STSTEM I HEREBY CERTIFY THAT 1 AY PROPERLY RE91STERED AND/OR LICEMftD AS REQUIRED BY LOS ANGELES COUNTY ANP STATE OF DISCONNECT PLUG AAD CALIFORNIA OR THAT 1 AY THE LEGAL OWNER OF THE ABOVIt ABANDON HOUSE SEMEN DESCRIBED RESIDENTLA PEATY. C BACKFILL SEPTIC TANKS ./ SEEP.PIT( ) ❑ CESSPOOLS SIGNATURE 1 OF PERMImL JOHN A- LAMSIE.COUNTY ENGINEER VALMATION____., ROBERT A.WOOD. CHIEF PLBa. INnPacTOR J�C 9 3 6 2- JJb i 7 -- 4 4.5 '� In