HomeMy Public PortalAbout8626 GARIBALDI AVE_Sewer__ 75A 8420 - CE808 - 9/73 APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION •UILDING
ADDER[••
LOCAL MY
KEA REST
FOR APPLICANT TO FILL IN CRONE •T.
LEGAL
D ESCII I PT I ON LOT NO. OWNER
PAIL
BLOCK TRACT Q ADDRESS
SIZE OF LOT I d NO. OF �+
NOW ON LOTOT•
L CTTY 7'[L NO.
U• OF DISTRICT NO. [ROUP AR [D ■U941
■UILQIMO•
S"E P S
CONTRACTOR
ADDRESS !Q[EGTIOZf D1STA
r. STATION DEPTH
CITY a TSL Nd.
•TAT[ LIC ! MANHOLE R[F[RKNCI U"EP
LICENSE NO L GLASS r v LOWER
No. I OESCRIPTION OF WORK FEE TYPE OF CONNECTION LENgTH FROM
HOUSE•EWER CONNECT NO TO Y. CURB P.L. M.L.TO P.L.
P SIL IC•[WItR *7.00
FTIC A • O[P OR P.C.NO.
PIT•AKD/OR DRAI NN ELD 510.00 CO.IMP.NO. JOS NO.
US[SEWER CONNECTING TO THUNK PlKRMIT NO. ROM PLRMIT NO.
PRIVATE DISPOSAL SYSTEM 51.00
CONNECT ADD O O AFFIDAVIT SAmS WDIQT RECORD.INS'R.NO. DAT[
Saw[w 0 55.00
OVERFLOW SEEPAgE PIT.DRAINFIELD O
E]CTN..CESSPOOLDRYWELL $5.00 LTMRAKIPAIR OR ABANDON HOUSE HWY.OR ST.WIDENINGC,
SEWER OR DISPOSAL SYSTEM 43,00 STAT[ENCROACHMENT
MAIIHOL[ . �•A0 PERMIT NO.
INDUSTRIAL
��pp��}��.pp���� WASTE APPROVAL
Onl\IM's PEUM S 00, CHARGES
CONNECTION CHARGE FEE
ADTHOI#IZATION !O'!AL FEE
I HAV[ AT THIS DATE A CONTRACT WITH THE HKJMIN NAMED CON. REIMSURf[M[NT FEE
TRACTOR TO COHN ECT THE ASOVE DESCRIBED LNG ING
ISTIDWOS.
TO THE PUSLIC SEWER. APPROVALS DAT[ INSPECTOR'S SIGNATURE
SIGNED THIS DAY OF -to—
OWNER OR NEW HOUSE SEWER
OWNER!AGENT CONNECT ADDITIONAL
ADDERS•/ SU ILDI NO OR WORK
SEPTIC TANK.SEEP.PIT(1)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION ARD/OR DRAINFI[LD
AND STATE THAT THEABOVE 1■ CORRECT AND AGREE TO COMPLY
.WITH ALL COUNTY 0RDINAN C[1 AND STATE LAW REGULATING SPOOL Cl DRYW[LI. ❑
L
BING AND SEW[R/.
ERSKY CERTIFY THAT 1 AM PROPERLY REOIS•1'ERED AND/OM ALTER.REPAIR.SEWER OR
SED AS REOUIRED ■Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
FORNIA OR THAT I AM THE LEGAL OWr1ER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, T`H[ A RI ID[NT L ABANDON HOUSE SEWER
ATURE EACKFI LLfi CTANKIPIRMTTTI �"
■[t P.PPTfS) CESSPOOLS
vALibATION �. 7 M.D. GSH
58I;E,l ! awl A. 1 3-.00A-%
COUNTS OF LOS ANGXLM TEttPLN CITY / 050E SZAER PZRXIT
DZPARTK"T OF PUBLIC WORKS 9701 LAS TUYAB SZ 0508 0604040001
BUILDING AND SIFRTS / LAND DEVZLOPWRNT TRIGL3 CITY CA 91780
PHONY: (616) 185-0488 EXT:
LZOAL ID. SRWZR SEPTIC: SZWER BUILDING ADDRESS:
TR. 5903 LTA 88 UN: .007 ZKIST OCC GRP. 8676 GARIBALDI AV
BLDG6. NOW ON .LOT. SCAB CA 917757616
ASSESSOR INFORNATION X014BKR: COYIECTIOi TYPIC NZARZBT CROSS STRIrT, BURTON
5386-014-079 ORIGINATION: THO34AS PAJ22: 596 GRID: G7 LOCAL=. TWOLE CIZT, C
LMN17M HL TO PL: STZTION, DEPTH:
TmYTP[ANHOLE RRYEREHCE: UPPEA/LOA•IR. ISSUED 6—Ni PROCRSBID BY: RSPIRRS ON:
04/04/06 JK 10/01/06
CONS DPROVR?UXT NWBER.
Olaml TICL. 10: PLAN CHECK NUIBRR, FINAL DA Y: CODE.
LHUN3, CHIN] (676) 589-8647- JOB KU BER. r'
8676 GARIBALDI 1VZ TRUNK PZRXIT NU BZRi
SCAB 917757611 ROAD PIRNCIT MM-EBZR. DISCRIPTION OF WORK
AP7>DAVIT: NO ALTERATION TO HOUSI SZAER
AASVIR: NO
APPLICANTc TIL. 10: EASEIQITc NO
LZUNG (676) 589-8647-
8676 GARIBALDI AVE RECORD IIBTRUN=T NBY. RICORD DATE: SPECIAL CONDITIOHB:
SCAB 917757611 HIGEAAY/STREET AIDEHING.
STATE 3i3ffCROACH3[IQT PER?QT IUIBER�
CONTRACTOR. TEL. NO: ISIS PAID APPROVALS DATI INSPECTOR SIGNATURE
LIUNG, ZRNIZ A (676) 797-1638-
8616 GARIBALDI AVENUE LIC. NO FIE DNSCRIPTIONi QUAHTITYi VOXi 1MOUIT: NIM HOUSE SSAER
SAN G&BRIZL, CA 91775 NONE
O1 PEOUT ISSUANCE FEE 77.75 CONNZCT I ITIOXII
15 1LT/RZP HOUSE SEAIR 1.00 ZAC 30.45 BUILDING OR WORK
ARCHITECT OR INGINKER. TIL. NO: TOTAL FENS 58.70
— BY FTIC 713TK, BEEPA,GE PIT
LIC. NO: AKD/OR DRAIN FIELD
DRTRZLL _
SZAZR XA.P BOOKS PAGE: ALTER, REPAIR, SZKZR OR
SEAAGZ DISPOSAL SYSTZK
DISCONNECT PLUG AND
ABINDON HOUSE SEWER
BACKFILL SEPTIC TASKS _
SEE)f. PIT CESSPOOL
GRAYWATER SSSTE![
REPORT IDi DPR166 ROUTZ TO B80508