HomeMy Public PortalAbout8721 GARIBALDI AVE_Sewer__ V DIPAICTMENT OF 0OU7VTY ENQII+TEM
DIVISION OF BUIMING AND SAFETY SEWER-SEWAGE DISPOSAL 1
OF LOS �� PERMIT APPLICATION
\
\ WILLIAM J. FOX. CourrrY F.J+vINr[R BUILDINGADDRESS ,
FOR APPLICANT TO RLL Ill
LOCALITY
BUILDING �"S / ! NEAREST
ADDRE86 7ZL- CROSS ST. �(
DISTMOT N0. SEWAL NO. PERMIT M0.
LooALmr ,_ �•-� _ �-- A � S
NEAREST � n
CROSS ST. RECEIVED BY RKY for Ippwtt" DATE ISSUED
OWNER 111-4e:
MAIL
ADDRESS S 7I- USE ZONE OOQUPANOY YAP
BK PG
CITY G TELNO. � �I G� X
CONTRACTOR
CO.IMP.N0.
[ 1 ADDRESS �. GC�r• •rte lr'L t
JOB NO.
CITY h . 1.(•_ TELNO. /� TRUNK PERMIT M0. —
�/ STATE /tr�
REGISTRATION NO. ���C�'3 C' T d ROAD PERMIT M0. = '
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. ' ASPERMIT NO.
BLOCK TRACT TE APPROVAL
RIAL
USE OF
SIZE OF LOT NO.OF BLDGS WN
NOW ON LOT CHARGES
BUILDINOS
La- y CONNECTION CHARGE FEE
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO REIMBURSES! E
PUBLIC SEWER ! i 880 RECEIPT NO. DATE BY
AiOUig SEWER CONN NB
PRIVATE DISPOSAL SYSTEM I.
CONN A I ZONAL BLDS.OR EXCEPTION ghORQED
WORK TO HOUSE SEWER 1.00
ALTER 6111 REPAIFUM NO- DATE Y
SEWER OR DISP0SAL SYSTEM I.00
DISCONNECT AND ABANDON SEWER
AMD/OB DISI-09AL SYSTEM 1.00 CONNECTION DATA
SEPTIO TANK, EEPA
PITS AMD OR DRAINFIELD 1.00 STATION DEPTH
CE POOL LL
SPECIAL CONDITIONS ONLY I-" i / M EFERENOE
UPPER)
TYPEF•CONNECTI LENGTH FROM
OWNERS PERMIT $ 1 OU RB -0.6,3. M.L.TO P.L
AUTHORIZATION TOTAL
1 HAVE THIS DATE OONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER _ c7
SIGNED THI AY OF `'� 19jLj� NEW HOUSE SEWER
OONNECT ADDITIONAL
OWNERS AGENT OWNER 0@ r L , �J �- C BUILDING OR WORK
SEPTIC TANK SEEP.PIT(8)
ADDRESS
AND/ORD RA1NFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE FIEAb%IS APPLI- CESSPOOL❑ DRYWELL E]CATIONAND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO 00MPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTS@ REPAIR 6filYER OR
REGULATING PLUMBING AND SEWERS. SEWAGE D18P01lAL SYSTEM
1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED
AND LICENSED AS REQUIRED BY LOS ANGELES COUNTYrAElANDODISCONOUBE6EWER
ANNECT PLUG AND
ND STATE'OF CALIFORNIA OR THAT I AY THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. PT OTAN SIGNATURE! ` (S)[] CESSPOOLS
OF PERMITTR /
TOA641D SU 1/83 /