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Home My Public Portal About8633 GARIBALDI AVE_Sewer__ 7/AS42D APPLICATION FOR P5RMIT COUNTYOF LOS ANGE T LES SEWER—SEWAGE DISPOSAL DEPAETh�'f OF COUNTY ENGINEER BUMDING AND SAFETY DIVISION ■U ILDI NG OHIf A. T-E�� Ca= En ADDRtu ` LOCALITY - NEAREST FOR APPLICANT TO FILL IN CROSS ST DESCRIPTION LOT NO. OWNER MAIL BLOCK TRACT ADDRESS NO. OF BLDGS. - ■IZE OF LOT HOW O LOT CITY NO. USE OF BUILDING■ DISTRICT NO ROUP MAP FROCKOSta BY 1!K PG CONT RACTOIS � d ADDRESS/ NNE ON DATA Cl TE.L. NO. ON DQTH REGISTRATION NO. COUNTY Y MANHOLE REFERENCE l FRS No. DESCRIPTION OF VVORK P/I[ TYPE of onN L R GTH FOM HOUR[SEW CONNKCTimQ TO Y. C .L M.E.TO PA_ PUBLIC SEWER a 155.00 F.C.n0. SEPTIC TANK.• G[FIT OR CO.IMF.NO. JOB NO. PT7S AND/OR DRAINFI[LD f [10.00 HOUSE SEWER CONNECTING TO TRUNK F[RMIT NO. ROAD PERMIT NO. PRIVATE DISPOSAL 5YSTEM $9.00 CONNECT ADDITIO AL ELDO.Ott AP 1DAVIT RECORD.INSTIL.NO. DAtZ WORK TO HOUSE SEWER 13.00 OVERFLOW SEEPAGE PTT,DRAINFI[LD ERT N.,C ES S PO O L.D RYW E L L,MA tj HOLT $5.00 AL ,R REPAIR ABA D U HWY. WIDENING ■EWER OR DISPOSAL SY 7.00 Y.OR S•TATE ENC CHMENT PERMR NO. INDUSTRIAL WAST[APPROVAL OWNS S PERMITs CHA"" AUTHOHPLATIrI ON I TOTAL FIMlCg CONNECTION CHARGE F[[ 1 HAVE AT THIS DATE.A CONTRACT WITH TH[ HEREIN NAMED CON- RIIMBURSEM[NT FEE TRACTOR TO CONNECT THE ASOVE DESCRIBED E)(ISTING DWELLING TO THE PUB41C SEWER. APPROVALS DAT[ INBP OIVS SIGNATURE SIGNED THIS DAY OF IG_ OWNER OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL A DDR[D■ BUILDING OR WORK SEPTIC TANK,S[Er.PIT(B) I HEREBY ACKNOV/LEDG[ THAT 1 HAV[ REAQ THIS APPLICATION AND/OR DRAINFI[LD AND STATS THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORD I NA NCBS AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWEI-L ❑ IHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED GISTRD AND/OR ALTER,REPAIR,SEWER OR LICS ENSED AS REQUIRED ■Y LOS ANGLEAHD STAT[ OF SEWAGE DISPOSAL■YSYE.M CALIFORNIA OR tH,T M TH[ LG ND INTEND TO DISCONNECT PLUG AND R UIPX IN, THE A [SSRI EER O t PERTY. ABANDON HOUSE S[W[R ■IGF PERE BACKFILL SKP C TANKS ❑ SEEP.FIT(B) u CED6POOLS �VAIMATION ROBERT A. WOOD M.O. CASH SUPERVISING MECHANICAL ENGINEER CK. 1 nl,o 4 4 0 4 i3 :'�'d . r3 1 1 A 2 5.0 G:. [FLMAL APPLICATION FOR PERMIT COUNTY OF LOS ANGELES DEP RTb= OF COUNTY GFar II= SEWER—SEWAGE DISPOSAL BUILDING AND SAFETY DIVISION BUILDING JOHN A. T KWMM ADDRESS WMIJAK A. Ta�x,��>��.�Q LOCALITY NEAREST FOR APPLICANT TO FILL IN "°°' 'T [DRAICRIpTION LOT NO. 17 MAIL OCK TR., Ls ADOR[SS NO. OF 01-10019.ZE OF LOT NOW ON LOT CITY NOor ILDIN00 DISTRICT Nb. 0)tOUP YAP j/ ■K PGNTRACTOR ADDRESS/ CO CTI N DATA CI -Td_ NO r ATION' D<TTH STATEMANHOLE REFERENCE PPQ REGISTRATION NO. COUNTY No. DESCRIPTION O WORK FEE -[ypE CONN LENGTH FROM HOUSE SEWER CONNECTING TO Y. C L M. TO P.L PUBLIC SEWER .5.00 P.C.NO. S IC T,lNK.S GE FIT OR CO.IMP.NO. JOB NO. FITS AND/OR DP AINFIEL'o .10.00 HOUSE■EWEROCONNECTING TO TRUNK PERMfT NO. ROAD PERMIT NO. PRIVATE DISPOSAL SYSTEM .7.00 CONNECT ADDITIONAL■ .OR AFFIDAVIT VAMN SN[[[IT RECORD.INS-M,NO, DATE WORK TO HOUSE SEWER "'00 OVERFLOW SEEPAGE PIT,DRAINFIX D I)Vr M_CIISPOOL.dRYW[LLMANHOLE 0 .5.00 ALTER.REPAIR 6R ASA DON HOUSE HWY.OR ST.WIDKNINO SEWER OR DISPOSAL SYSTEM $33.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'S PEHMTf s z 00 CHARGES FI[ AUTHORIZATION TOTAL FEE CONNECTION,CHARGE I HAVE AT THIS DAT[ A CONTRACT WITH TH[ HEREIN NAMED CON- R[IMSURS[M[Kf FEE TRACTOR TO CONNECT THE ABOVE DESCRIWM EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS DATE INSP[ OR-15 SIGNATUR SIGNED THIS DAY OF, 1G_ OWNER OR NEW HOUSE SEWER OWNERS AGENT ��d CONNECT ADDITIONAL BUILDING OR WORK ADDRESSBUILDING TANK.BEET,PIT(8) IPI ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD ANDSTAT[ THAT THEA00VK 16 CORRECT AND AGR[[ TO COMPLY WITH L H AL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AHD SEWERS. CESSPOOL ❑ DRYW[LL ❑ I HEREhY CERTIFY THAT I AN PROPERLY REQISTERLD AND/OR ALTER,REPAIR.SEWER OR LIC[N.ED'AS RIGUi RED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM CALFPORNIA OR THAT TH[ LEGAL O , AND INTEND TO DISCONNECT PLUG AND RESIDE IN, TH[ AlRISER R IfTI OPE RTY. ASANDON HOUSE■EWER ■SOF PKRM BACKFILL S[PBC TANKS ❑ OF P<12 MTT1ZT REI..PIT(S) u C1"POOIJ ALIDATION ROBERT A. WOOD M.O. CASH SUPERAR VISING MECHANICAL ENGINEER C!(. u i-0 4 4 0 3 I'M S 1 0 A 7.G 0- i