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Home My Public Portal About9644 GIDLEY ST_Sewer__ 76A 6420-CE808-10-71- APPLICATION FOR PERMIT COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING U r / ADDRESS Cry LOCALITY FOR APPLICANT TO FILL IN NEAREST CROSS ST. LEGAL DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS NO. OF BLDGS. �1 SIZE OF LOT NOW ON LOT CITY (,N' TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP BK MAP PG PRO ESSED BY CONTRACTOR ee; (.,o�L� !'- ADDRESS r7 CONNECTION DATA I STATION -- DEPTH CITY /Q TEL. NO. STATE ��j �Z•L A'S5 L� MANHOLE REFERENCE % - ,/' UPS ool LICENSE NO;; J L �/ NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION LENGTH FROM f1 HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. (, PUBLIC SEWER $7.00 P.C.NO. SEPTIC TANK.SEEPAGE PIT OR CO.IMP.NO. PITS AND/OR DRAINFIELD _ @ $10.00 4 JOB NO, HOUSE SEWER CONNECTING TO TRUNK PERMIT NO, ROAD PERMIT NO, d PRIVATE DISPOSAL SYSTEM @ $3.00 O CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER I-EASEMENT RECORD..INSTR.NO. i DATE U WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD Im EXTN.,CESSPOOL,DRYWELL. @ $5,00 ALTER,REPAIROR ABANDON HOUSE HWY.OR ST.WIDENING O SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT MANHOLE ® $7.00 PERMIT NO. 0- INDUSTRIAL INDUSTRIAL W WASTE APPROVAL Z OWNERS PERMIT S a 00• CHARGES AUTHORIZATION TOTAL FEE &06 CONNECTION CHARGE FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE TRACTOR T0C ONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLISEWER. APPROVALS DATE INSPECTOR'S SIGNATURE SIGNED THIS ZZ' DAY OF :3ft~ 19 OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTYORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL Q I 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, AND INTEND TO DISCONNECT PLUG AND L RESIDE IN, THE ABOVE SCRIBED RESIDENTIAL PROPERTY. ABANDON HOUSE SEWER R9- SIGNATURE / BACKFILL SEPTIC TANKS ❑ OF PER MTTTEE SEEP.PIT(S) ❑` FSSPOOLS ❑ VALIDATION CK. M,.O. CASH I _L r D 5&E-689 11-55 APPLICATION FOR PERMIT 1 3&E-8 DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL DGP=tment of County Engineer County of LOS Angeles BUILDING JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS ® CAS SATT D.GRIFFIN, SUPT OF BUILDING LOCALITY FOR APPLICANT TO FILL IN CROSS sTi! LEGAL DESCRIPTION LOT NO, 5 — OWNER BLOCK TRACT ADDRESS / (� NO.OF BLDGS. CITY TEL. N0. 1 SIZE OF LOT NOW ON LOT USE0 F OF BUILDINGS DISTRICT NO. GROUP MAP J BK PG CONTRACTOR Able Constr. ,1%iLL CONNECTION DATA ADDRESS 225 WPet Bryant s STATION DEPTH CITY E1 Monte TEL. N0. Gi 8-6565 MANHOLE REFERENCE PPER REGISTRATION NO, 168579 o COUT TY - � NO. DESCRIPTION OF WORK FEE TYPE OF TION LENGTH FROM HOUSE SEWER CONNECTING TO •y� Y. CURB P.L. M.L.TO P.L. - PUBLIC SEWER @ $3.50 V SEPTIC TANK,SEEPAGE PIT OR PITS AND/OR DRAINFIELD @ $3.00 J OVERFLOW SEEPAGE PIT,DRAINFIELD CO. IMP. NO. . i ESCTN.,CESSPOOL,DRYWELL,MANHOLE Q $2.00 JOB NO i HOUSE SEWER CONNECTING TO i PRIVATE DISPOSAL SYSTEM @ $1,00 TRUNK PERMIT N0. ROAD PERMIT NO. � S CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT i WORK TO HOUSE SEWER Q $1.00 PERMIT NO. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL _ SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL CHARGES CONNECTION CHARGE FEE OWNER'S PERMIT 5 1 00 REIMBURSEMENT FEE AUTHORIZATION TOTAL FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. NEW HOUSE SEWER. SIGNED THIS D. OF 19 CONNECT ADDITIONAL OWNER OR OWNERS AGENT-vi;x BUILDING WORK SEPTIC TANK, SEEP,PITS) ADDRESS AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL❑ 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 SYSTEM I HEREBY CERTIFY THAT 1, AM PROP Y REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY 0S ANGE S OUNTY AND STATE OF ABANDON HOUSE SEWER CALIFORNIA OR THAT I A' THE LE AL OWNER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS❑ q i' SIGNATURE ' SEEP.PITS) ❑ CESSPOOLS La OF PERMITTEE, JOHN A. LAMBIE. COIJ Y ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PLBG. INSPECTOR CK. N.O, CASH € AGo4 61 3L SEP 1 A 4.5 ( 0'1.