HomeMy Public PortalAbout8619 GARIBALDI AVE_Sewer__ y•"•D
■i 46Q]it-5A APPLICATION FOR PERMIT 1
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
co" of Im Angsies;
JOHN A. LAMBIE, COUNTY ENGINEER
m CAQUATT D. GRIFFIN, SUPIT OF SUILDIIio LOCALITY Q,
'rOH' APPLICANT IN
1 N 104 /S7 OWNER
B CT S7_ 3 MA 14
ADDRESS
r XO.OF BLDGS. �� CIT1 TEL. X0.
SIZE OF LOT a X XO►ON LOT
USE 0
BUIILDF � DISTRICT X0. GROUP YAP
K �G
CONT RA CTO
ADDRESS CONN=ON DATA
STATION DEPTH
CITY G+ TEL MANHOLE REFEREA LP;KR
❑ STATE
REGISTRATION NO. ❑ COUNTY
No. DESCRIPTI N OF WORk FEE
HOUSE SEWER CONNECTING TO TYPE OF ON NGTH FROM
PUBLIC SEWER
Y. P.L. M.L.TO P.L
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAIXFIELD 9.00
OMFLOW SEEPAGE PIT,DRAINFIELD P. C. No-
i
ETN.,CMP-OOL,DRYWELL MANHOLE 2.00 CO. nOP. N0. JOB MO.
i HOUSE SEWER CONNECTING TO
i
PRIVATE DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SERER $1.00 PERMIT XO. -ALTER.REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 11.00 WASTE APPR0II j
IV IV CHARGES
CONNECTION CHARGE FEE _ -
OWNM'S PEEWT s 00
AUMORMTION TOM Fa
REIYBURSEYENT FEE
1 HAVE AT THIS DATE A CONTR/1CT WITH THE HEREIN RAYED COX- MmovALS DATE IXBP CTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING EL ING
TO THE PUBLIC BEWER. NEW HOUSE SEWER i
SIGNED THIS A F 19 CONNECT ADDITIONAL
OWNER OR BUILDIN OR WORK
0\lXERS G SEPTIC TANK,SEEP,PIT($)
ADD R AND/OR DRAINFIELD
1 H EBY ACKMOWLEQ6E THAT I HAV EAD THIS APPLICATION C$SSPOOL❑ 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 SYBTEM
I HEREBY CERTI HAT 1 AN PROPERLY REGISTERED AND/UK DISCONNECT PLUG AND
LICENS RE RED BY LOS A ES COUN AND &TATE OF ABANDON HOU E S9WER
CALIF IA OR rHAT 1 AY TH GAL OWNE BOY
D EXTIAL PROPE BACKFILL SEPTIC TAXKB❑
81 SEEP.PITS) CESSPOOL,
Y �
JOHN A. LA E, COUNTY ENGINEER VALIDATION ROBERT A.WOOD, I PLDG. INGPECTOR
u. ■.0.
LnJo4 7 9 -APR g 1 4 h 6.0 0i .