HomeMy Public PortalAbout8631 GARIBALDI AVE_Sewer__ °= APPLICATION FOR PERMIT
7"DO COUNTY OF LOS ANGELES L1
DEPARTMENT OF COUNTY ENGINEER SEWER SEWAGE DISPOSAL
BUILDING AND SAFETY DIVISION BUILDING
O� T 3010- + SK ADDRUB
WMLIAX & �, af $�°BnQ
LOCALITY
NEAREST
FOR APPLICANT TO FELL IN CROSS STLFL .
DEBCRIPTION LOT NO. J OWNER
BLOCK TRACT O
ADDR[°1 ✓�
{ NO. OF BLOGS. e
SIZE OF LOT/ NQW. ON LOT C TEL. NO
A T
BUU]BE NOF DISTRICT NO. OROUr MAF try
SK^n
■K ro
CONTRACTOR
ADDR[BS `fJ /CONNECTION DATA
T STATION /_ D[FTH
CITY TIL NO. (�
Iy
6TATI Urmm
MANHOLE R[F[
R[OI]BTRAT101� MO. � COUNTY
NO. DESCRIPTION OF woRK F;[ TYPE 4wp.mNKcTiom Ln�GTI-I FROM
EE
HOUR[SWR CONNECTING TO Y. CURE .L M.L TO!.L
PUBLIC SEWER S5.00 P.C.NO.
-RUPFIC T#NK,BEEP G[PIT ORCO.IMP,NO. JOB NO.
PITS AND/OR DRAIMFI[LD 310.00
HOU■E SEWER CONNKCTING TO 1 OAD P.rr NO
PRIVATE DISPOSAL SYSTEM 37.00
CONNECT ADDITIONAL BLDG.OR AFFI • ■ fiIR E RD.INSTR.NO. DAT[
WORK TO HOURE BEW[R $3.00
OVERFLOW SEEPAGE PIT,DRAINFIE7�
U[TM.,C[]BSPOOL,DRYWELLMANHOLE 0 SM.00
ABANDON tlOUB HWY.OR ST.WIDENING
]BllV[R••�^ �Si $3.00 �
STATE ENCROA M[NT
PERMIT NO.
INDUSTRIAL
WAST[APPROVAL
OWNER`S PESMT i 2 00 CHARGES
CONNECTION CHARGE F[[
AUMOEIZATION I TOTAL FEE
I HAVE AT THIS DAT'[ A CONTRACT WITH THE HEREIN NAMED CON-
REIMBURSEMENT FE[
TRACTOR TO CONNECT THE ABOVE D[SCRIStD EXISTING DWELLING TO
TO THE PU rLIC °EWERA
. M NU
DAT[ INSPECTOR'S SIGATRE
SIGNED THIS_DAY OF
OWNER OR NEW HOUSE SEWXR
OWNER]B AGENT CONNSCT ADDITIONAL
ADDRESS ]BUILDING OR!WORK
SEPTIC TANK,Ste,PIT(S)
1 HEREBY ACKNOWLEDGE THAM 1 HAVE READ THIS APPLICATION AND/OR DRAI N F I
ELD
AND STAT[ THAT THE ABOVE 1■ CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY 0RDINANC[1 AND STAT[ LAWS REGULATING CE]BS POOL ❑ DRYW[LL D
PLU MEI
AND SEWER.
I HEREBY CERTIFY THAT IAM PROPERLY R[GIVI KRI D AND/OR ALTER.RI FAIL.SEWER OR
S
LICKNS[D AS R[GUIRID BY LOANG LFJ6 COUNTY AND STATE S
OF ° WAG[DISPOSAL SYSTEM
CALIFORNIA bR THAT I AM THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AHD r
RF.8ID[ IN, TH[ A OVE D [D I IAL PR [RTY. ARAN DOH YOUSE G A[R J
■I0F PERM
BACKFILL SElT14 TANKS ❑
OF PL1tM1 SE�.PTT(B) ❑ CEBSPOO(J
ALIDATIO ROBERT A. WOOD
CK. M.D.
SUPERVISING MECHANICAL ENGINEER
CATH
X293 -9 F?R 413 A 5.00 V
C"063-811 APPLICATION FOR PERMIT -
TGKJC64LDe4zD COZrNTY OF IAS ANGELES Ll
SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUMDING AND SAFETY DIVffiION euILDINo
JOHN A. LAME17 �I;./� En ADDRW
wa .0
r* A.lAX JENSEN, Sup't of `
LOCALITY
NEAREaT
FDZSCIoN
B APPLICANT.JTO FILL IN cRDSa R.
LOT NO. / OWNER
MA LL
TIRACT O ADORE"NO. OF BLDUS.
NOW ONLOT CIT' TEL. NO.
DISTRICT NO GROUP MAP rROCESSED BY
-�^
ADDRESS CONNECTION DATA
CITY/ TEL STAT I OH DEPTH
STATZ MANHOLE REFER"- PPS]t
REGISTRATION NO. �� COUNTY
No. DESCRIPTION OF WORK FEE TY rB F Co ION LENGTH"OM
HOUSE•EWER cONN[CTI O TO Y. P.L M.L TO PA_
'In'
U BLIc SEWER 4 $8.00
P.0 No.
D IC TANK.• AINFI PIT OR CO.IMP.NO, JOE NO.
FITS AND/OR DRAINFI[LD SIO.00
HOUSEER
E• WCONNECTING TO TRUNK P[RMI NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL ISLDG.0vt AFFIDAVIT I •Ami I 4"Ko 1T RECORD.INSTR.NO. DATE
WORK TO HOUSE SEWER 53.00
OVERFLOW SEEPAGE PIT,DRAINFI[LD
[7L7-N..CLSSPOOL,DRYWELLMANHOLE 0 55.00
AL P1.IR O ABA DON HqU 6 HWY.OR ST.WIDENING
SEWER OR DIBPOOAL SYSTEM 7.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WAST[APPROVAL
OVVNER"S PERMIT $ z 00 `HA" KS
AUTHORIZATION rorAL FEE CONNECTION CHARGE FEE
I HAVE AT TRI• DAPI A CONTRACT WITH THE HEREIN NAMED CON-
REIM■URSEIIENT FEE
TRACTOR TO CONNECT THE ABOVE D[SCRFB tD LE ISTINO DW[Lilryq -Y_O�
TO THE FUBLIC SEWER. APM DATE INST[CTO R'S 910 KATU R[
SIGNED TH18 DAY OF. Ifl_
OWNER OR NM HOUSE SEWER
OWNERS AGENT
CONN[(.T ADDITIONAL
ADDRESS BUILDING OR WORK
■EFTIC TANK.BEST,PIT(S)
1 H
HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AD/OR DRAINFI[LD
AND STAT[ THAT THEABOVE ID CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCE/ AND STAT[ LAWB REGULATING CESSPOOL El DRYWILL ElPLU MING ANP SEW ERD.
I H[R[BY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER.REPAIR,SEWER OR
LICENSED AD REQUIRED BY LOO ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TH AM TH[ LEGAL ER OF, AND INTEND TO DISCONNECT PLUG AND
REDID[ IN, TH[ A DESCRID IkL rR OP[RTY. ABANDON MOUS[GEH/tR ,
SIGNATURE ❑
OF FERMI T. SACKFIf IC TANKS
EEv.FrTrr(S) Li cnMIPobLe
VMMATION ROBERT A. WOOD
M.O. CASH SUPERVISING MECHANICAL ENGINEER
CK.
4 4 0 : ,Yf 8 1 o A 5,00
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