HomeMy Public PortalAbout8635 GARIBALDI AVE_Sewer__ 7"641DAPPLICATION FOR PERMIT
COUNTY of LOS ANGES
ELSEWER SEWAGE DISPOSAL,
DEPARTTYBMENTM OF COUNTY ENGINEER
$UMDING AND SAFETY DriMION 7X@8
JiOHN A, L&KMR.WIIJJd3( A. IEIMER, bnp'f of B>¢1�4
FOR APPLICANT TOa FILL IN LJKaAL
DESCRIPTION LOT NO. `■LOCK TRACE
NO. OF ELDQY.
SIZE OF LOT OW Ory LOT 4(TY L. NO.
US[ OF
BUILDINGS DISTRI CT 14 GROUF MAP F EDb ED BY
eK ra
CONTRACTOR
ADDn '1 CONIU=a DAT
ctrY• rEL. No. �g�f
er Io
STAT[
REGISTRATION NO. COUNTY MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE TYrR OFCON CT LLNGTH FROM
GUS[SEWER CONNECTING TO Y. C P.L. MA_TO P.L
PUBLIC SEWER /8.00 F,G NO.
E[PTIC TANK.SEEPAGE FIT QR Co.IMF.NO. JOE NO.
FITS AND/OR DRAINFI[LD L $10.00 �J
HOUSE■[Will CON n[CT [9.00 P[
FRLVAT[pIdPO■AL SYSTEM TO TIRVNK PERMIT NQ. ROADRMTT NO. /
�
CON N[CT AQDITIQNAL■ .OR AFFIDAVIT [IUM[v l rxmFfT RECORD.WR
ST .NO. DAT[
WORK TO YOU SEWER $3.00
OVERFLOW SEEPAGE PIT,DRAINFIKLb
E)(TN.,Ci■BPOOLOR PMOL[Q $3,00
ALTER.RAIR O O ■ HWY.OR ST.WIDiNINCI
E[W[R OR DISP L 9.00 STAT[ CROACRY
HERMIT NO.
INDUSTRIAL
WAST[ARPROVAL
OWNER'S PERDUT :
AUTHORIZATION TOTAL FEE connECTlon c�1AROE F>;E
1 HAVE AT THIS DAT[ A CONTRACT WITH THE H[REI71 NAMED CON-
R[IFOSURDFM[NT FEE
TRACTOR TO CONNECT THE ■
AOVK DESCRIBED DELETING DWELLING `y
TO TH[ P ELIC SEWER. APPRO•AT S DATE INSP CTOR'■SIONATURK
E
SIGND THIN DAY OF,
OWNER OR NEW HOUSE SEWER
OWNERS AGENT_ T, 4OHN[OT ApDITIONAl,
ADDRESS BUILDING OR WORK
SEPTIC TANK,DEET,FTT{S)
1 HERESY ACKNOWL[DO[ TFtAT I HAV[ READ TH 19 A►PLICATION
AND STATE THAT THE ASOVE IB CORRZCT AND AOR[[ TO CQMPLY AT/D/OR DAAINFI[LD
WITH ALL COUNTY 0RDINAN CED AND STATE LAWS REGULATING CLDPOOL [I DRYW[I1
PLUM Is
Iwo AND SEWERD. Ej
1 FIERYBY C[JITIFY THAT I AY FROPERLY R[GIST[Rtb AND[OR ALTER,REPAIR,SEWER OR
LIC[ [D AS RtOUIRI D BY LOS ANGLES COUNTY AND ■TATL OF SEWAGE DISPOSAL SYSTEM
CALI ORNIA OR THAT I AM 7HE LEGAL O OF, AND INTEND 70 DISOONN[GT Ptub AND
Ri■ID[ IN, TH[ ABVE -11
O1E[D R RTY
OP[ . ABANDON HODS[■[WAR
d1O NATURE SACKPILL S[PBIC TANKS ❑
OF P[RYITT[E SEEP,FIT(a
) LJ C[SSP004.S
�`TAMATION R013ERT A. WOOD
Y.O. CASH SUPERVISING MECHANICAL ENGINEER
CK
0do rV1Y C� 1 J_ A 2 5.�)0 P.
7GA641D e1 APPUCATION FOR PERMIT
7SAe41
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUIWING TAND SAcF�E�TtY� pDMSION ,�,00Ru.
VVII1.iAl[JOHN A. J�E�f, 1.Il�d�q
LOCALITY
NCAR
FOR APPLICANT TO FIILI. IN c"°'• `T
D[.SCRIPTION LROAL
LOT NO. OWNER
D MAIL
BLOCK TlUCT ADD RSI■
NO. OF ■LOGS.
SIZE OF LOT NOW ON LOT Crry TIL NO.
USE OF
BD ILDIN G■ DISTRICT No. GROUP MAPSED.BY
1K to
CONTRACT OCR
ADDRE" CONNEC DATA
CITY TIL NO.
REGISTRATION NO. snllol MANHOLE R[F"IENC[ r
NO. 'DESCRIPTION Oft WORK FII TYPE of CON LIN TH FROM
HO S!a CONN ECTIryG TO Y. .L Y.L.TO P.L
PUBLIC SEWER
[R 0 Jd.00 P.C.NO.
SEPTIC TANK.SEEPAGE PIT QR CO.IMF.NO. JOS NO.
PITS AND/OR DRA I N FI[IJ) 0 SIO.00
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL IYSTIM $1,00 TRUNK PERWT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR AFFIQAVIT I ■AIR[ W[■[R RECORD.INSTR.NO. DAT[
WORK TO HOU/E SEWER t 57.00
OVERFLOW SEEPAGE PIT.DRAINFLELD
[ETN.,C[IBPOOL.DRYWELLMANHOL[0 *0.o0
AL .REPAIR OR ABANDON OUSE HWY.OR ST.WIDENING
SEWER OR DISPOSAL SYSTEM 13.00 STAT[VICROAGHM[M
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
O 3 cHAkau
PERMIT s 2 00
AUTHORIZATION T OTAL FE C014NIEC710H CHARGR FE[
I HAVE AT THIS QATE A CONTRACT WITH THC HEREIN NAMED CON. R11"URBEMENT FEE
TRACTOR TO COHN[CT THE ASOVI DEsc HIBm E)SISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DAT[ ImSP[CTb R'S SIGNATOR[
SIGNED THIS DAY OF. ID_
OWNER QR NEW HOIJOK SEWER
OWNERI AGENT CONNXCT ADDITio NAL
ADORES{_
■UJLDI Na OR WORK
SEPTICI HERErY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/QR
DR[AIAPJK,■�,PIT(S)
AND�QR ORAINFI6Lk!
AND STATE THAT THE ABOVE IS CORRECT AND AOR[[ TO COMPLY
WITH ALL COUNTY 0ROII{ANC[S AND STATS LAW■ REGULATINQ
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
IHERESY CERTIFY THAT I AK PROPERLY REGISTERED AND`OR ALTER,REPAIR.SEWER OR
LIC[N*SD AS REOLJIRED BY LOIk ANGLES COUNTY AND STATS OF SEWAGE DISPSS
OAL SYSTEM
KM
FORMAOR TWAT M THE LEGAL OF, AND "TEND TO DISCONNECT PLUG AND'
RESIDE LN, TPI[ A [SC111BED EN PROPERTY.
ABANDER
ON HOUSE SWE
SI014
0F=,,, BACKFILL SEPTIC TANKS ❑
SEEP.PIT(S) ❑ CESSPoO LJ
VMMATIOI4 ROBERT A. WOOD
cK
N.0. CASH SUPERVISING MECHANICAL ENGINEER