HomeMy Public PortalAbout9641 GIDLEY ST_Sewer__ `EB° >, APPLICATION FOR ERMIT
76A 642D.
OF LOS ANaE� SEWER-SEWAGE DIS L
OF COUNTY ENGUCM
BUELDING AND SAFETY DWIMON BUILDING
JOHN A--'rte. &W,l at B-n ADDRESS
_ LOCALITY
NEAlIST
FOR LE L
DESCRI ON LOT 110 OMI V14
MAIL
BLOCI TRACT
OF BLDGS.
SIZE OF LOT ON LOT `7
` USE OF
BUILDI DI1711CT XO GROUP MSF RT
CONTRACTOR s f _ /
ADfH3tn COlQU3CTI� =/DATA
CITY "1.NO INV o! DEPTH
'MkXHOLE REFERENCE
REGISTlATlON NO COUNTT
No D
HotlSEC CORNICTIN• TO
it FnU�tBL�I OF XX L[XaTN /
C [ S�AQ I FIT O! ! TO P
FITS All OR bRALN
0 LOWMlz
Aa PI D NrTELD
0 bt CONN G TO P.C.NO- O
CO.11P. Ito. JOB NO V
CONNECT ADDITI v PER
UG TRUNK FSRl1IT No. ROAD Pnxrr fx
O
AOR[TO HOl1SHo SUSS STAT[[IICROACH![AT 0
.00 F£REIT N0. UL
INDUSTRIAL 4
Z
0WNEI .7 PEOCT CONNECTION CHART[FSI
AUTSORMAnON TOTAL F= RIIMBURSEMEIIT FEj
I HAVE AT THIS DATE A CONTRACT WM TNI HEREIN ihMXD CON-
TRACTOR TO CON=THI ADM 1Z�BED ETJSTIN9 MV-UN9 APPRO DAT[ IRSFE *SSI
TO THE IUBLIC 18�.
SIGNED THIO DAT OF l>i_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS Ago" BUILDING OR WORK
ADORMN SEPTIC TANK,SERF.FI (S)
UI R DRAINFIRLD
I HEREBY ACKNOWLEDGE THAT K HAVE RW THIS APPLICATION
AND STATE THAT THE ADM IS CORRECT AND AGREE TO COMPLY CESSPOOL DRTWK
WITH ALL COUNTT ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS. SAVAGE
AFFAIR, L IrYSTIKV
0!
S
I HEREBY CERTIFY THAT I A■ FNA
DISCONNECT PLUS AOPERLT REGISTUM AND/OR EWAGE DISPOSAL
LICENSED AS REQUIRED BY LOS AXGE�E.S COU AND STATE OF ND
ABANDON HOUSE SEWER
CALIFORNIA OR THAT I Al aAl OWW OF TEX ABOVE
D[SMBED BACKFILL C TANKS
SIGNATURE SM.PIT($)
OF FERMI
/- ALMATIOx ROLBEFrr A. WOOD
L"6766ti NOV 9 :10 D 7.0 0- U
E808 3-6. /AL�PL�V' I FOR PERMIT
E 083 MMM��r
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
D AATMENT OF COUNTY ENGI
UILDING AND SAFETY DIVISION BUILDING
JOHN A, LAMBIE. County Engineer ADDRESS
WILLIAM A. JENSEN, Supt of Building_ LOCALITY YL
NEAREST /
FOR APPLICANT TO FILL IN CROSS
LEGAL OWNER
DESCRIPTION LOT N0. dY� T(�
BLOCK TRACT / MAIL
ADDRESS
NO.OF BUGS. _' -
S12E OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO.NO. GROUP MAP PROLE D BY
CONTRACTOR l U( BK GG / ` /
ADDRESS �� / CONNECTION DATA /_
CITY TEL N0. _'D y� ION _ DEPTH
MANHOLE REFERENCE -� PPER
REGISTRATION N0.// COUNTY
0. DESCRIPTION OF FEE -
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.00 E TH]N LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR C P.L. N.L.TO P.L.
PITS AND/OR DRAINFIELD @ S3.00
OVERFLOW SEEPAGE PIT. DRAINFIELD
EXTN.. CESSPOOL DRYWELL @ $2.00
HOUSE SEWER CONNECTING TO PC.
NO.
PRIVATE DISPOSAL SYSTEM @ 5L00 CO. IMP. NO. JOB NO.
WORK
CONNECT
CT OUSEISEWER LDC.OR @ SI.00 TRUNK PERMIT NO. ROAD PERMIT N0. _
ALTER RE AIROR 8AN H BE STATE ENCROACHMENT
SEWE OR ISPOS bY5 @ 51.00 PERMIT NO.
INDUSTRIAL
WASTE APPR
C
OWNERS PERMIT fwelcr CONNECTION CHARGE FEE
WTHORIZATION TOTAL FEE C)v REIMBURSEMENT FEE
HAVE THIS DATC ARACTORA TO CONNECT THE ABOVET DESCRIBED EWITH THE XISTIINGAMED DWELLIING APPROVALS DATE INSPECTORS SIGNATURE
0 THE PUBLIC SEWER.
;IGNED THIS DAY OF 19— NEW HOUSE SEWER
WNER OR CONNECT ADDITIONAL
VNERS AGENT BUILDING OR'WORK
ORES B SEPTIC TANK,SEEP. PIT(S)
AHD/OR DRAINFIELD
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
0 STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL ❑ DRYWELL ❑
fH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
IMBING AND SEWERS. ALTER.REPAIR.SEWER OR
SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
ENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
'FORNIA OR THAT 1 AM TH LEGAL WNER OF .THE ABOVE
9 BACKFILL SEPTIC TANKS [I
EBE
' RESID TI T. / SEEP.PIT(S) CESSPOOLS
CKERMITTE
/PAL ROBERT WOOD
M..O.0. GAN SUPERVISING MECHANICAL ENGINEER
6 7 6 7.,; iauU G