HomeMy Public PortalAbout9634 GIDLEY ST_Sewer__ CEO" APPLICATION. FOR PERMIT
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COUNTY OF LOB ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVIBION ■u1LDINo
JOHN A. LAMBIE, COUNTY QNGIN[[R ADO"[" �T
COLEMAN W. JENKINS. SUPT. OF BUILDING
LOCALITY
R EA REST
LXGAL
FOR APMCAM TO EM IN cRDB■ n.
DLSC RI FT I ON LOT NO. OWNER
MAIL ^
/LOCK TRACT A00Ra1 �J
NO. OF SLDOS. Y
SIRE OF LOT NOW ON CITY TIL. NO.
U/[ OF
BUILD111GS DISTRICT NO GROUP MAF ry
CONTRACTOR O D
ADD REM COlQf MON all'fA
CITY Q L TEL. NO. STATION DEPTH
/TAT[ LRC MANHOLE REFERENCE FPR
LIC SE IVO. CLAP
ND. DESCRIPTION OF WORK FIE TYPE OF CONNECTIONL T
CAH P06M
HOUSE■EWER CONNECTING TO Y. CURB P.L- M.L.TOP .
PUBLIC/EWER 625.00
P.0 NO.
SEPTIC-IANK.sJMPAaE PIT oit
CO.IMP.NO. JOB NO. '
PITS AND/OR DMINFI[LD � 5I0.00
HOUR[SEWER CONNECTING TO TRUNK PERMrr NO. ROAD PERMIT NO.
PRIVATE DI■POSAL SYSTEM /7.00
CONNECT ADDITIONAL a AFFIDAVIT wmVil W rwT RECDRD.INSTR.NO. DATE
WORK TO HOUSE SEWER 33.00
OVERFLOW @K"AGE PIT.DRAINFIEL.D O
[XTN..C[S*POOL.DRYWKI I MANHOLE 58.00
DON O
EHWY.OR ST.WIDENING 15
■ W[R1 YSTEM $3.00 STATE ENCROACH M EMTcL
FERMIT NO. _
INDUSTRIAL
WASTE APPROVAL
OWNEB'8 pEHMri s x 00 CHARGES
AUTHORIZATION TOTAI. Fly i D CONNECTION CHARD[ [
I HAVE AT THIS DAT[ A LORTRAcT WITH THE HEREIN NAMED CON. IQIMDURSEMEMT"M �
TRACTOR T0.CONNECT THE ABOVE DESCRIBLD EXISTING OW[LLI NG R77Ef1oOVA1�
TO THE PUBLIC ■[WI APPR DATE INSP'ECTOR'S SIGNATURE
SIGNED THIS DAY 10
OW`NOW [EM AG[MT� CeM� 14'et1Ef� NEW HOUSE SEwQ
CONNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.SEEP,PUT(S)
I HEREBY ACKNOWLEDGE THAT 1 HAV[ MUD THI■ APPLICATION
AND STATE THAT THE ABgVE IS CORRECT AND AGREE TO COMPLY AMID/OR DRAINFI[LD
WITH ALL COUL7ADF-ar-I
S AND STATE LAWS REGULATING
PLUMBING AND CEJSPOOL Q DRYWELL ❑
1 H[REoY CERM PROPERLY REGISTOfED AND/OR ALTER,REPAIR.8EWER OR
LICENSED Al RS NOL U AND STATE OF SWAG[DI9P0IAL SYSTEM
CALIFORNIA OR
LiGAL [M AND INTEND TO DISCONNECT PLUG AND
AESIDE IN, TH[ ED PROPERTY. ASANDON HOUSE SEWER 1
SIGNATURE 11
a&
PERMITIa BACKFILL SEF�IC TANKS
SEEP.PIT(S) LJ CESSPOOLS
AlWATION JACK R. ALLIIN
Y.O. CASH OUPERVIBING MECHANICAL ENGINEER
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