HomeMy Public PortalAbout8727 GARIBALDI AVE_Sewer__ CR[0[ 10.Q2 ,
70A"AD APPLICATION FOR PERMIT
COtINTDEPARTMENT
OF LOS ANGELESGI SEWER—SEWAGE DISPOSAL
DEPAHT'MErfT OF COUNTY ENGII�
BUILDING AND SAFETY DIVISION BUILDING �� ' �
IQ$x A, T i11RTR }T Eyq��[ ADDR[[A
WaILAX & IENSF , Su—p'{ of Dalldthg
LOCALfTY
NX"XBT
FOR APPIJC TO FILL IN cRDBB '7.
DESCRIPTION SOT HO OWNER
MAIL
[LOCK TRACT ADDRESS
NO. OF BLD OB_
-SIZE OF LOT NOW ON OT CITY N0.
UBC OF
BUILDINGS DI"MICT-NQ. GROUP MAP PROCESSED BY
`^ BK PO
CONTRACTOR
ADDRREB C GTION DATA
CITY T[L.
ETAYI ON DEPTH
NO.
STAT[ U PP'R R
MANHOLE R[FEREN C LOWER
RTU
EOISTTI NO. COUNTY
NO. DESCRIPTION OF WORK rim TYPEHIIECTIOII LENOT14
HOU[[BEW[R CONNECTING TO Y. o OU F.L. Y.L TO P.L
PUBLIC S[WXR 58.00
SEPTIC TANK,6 AGE PIT OR NO.
.G NO.
PITS AND/OR DRAINFIELD � [10.00
CO.IBP.NO. ■
HOUA
BE SEWER CONNECTING TO TRUNK PERMIT NO. ROD PERMIT NO.
PRIVATE DISPOSAL SYSTEM 43.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT •Arm I Lugw E #[CORD.IIISTR.NO. DATE
WORK TO HOUSE REWER 43.00
OVERFLOW BEEPAGE PIT_DRAINFIELD
KXT N.,CEY S PO O L,D RYW[LL,MA H H O L[ $5.00
R, O HWM.OR ST.WI&Kf4ING
BEWER O 9.00 NATE xmcR6ACHMXN7
PERMIT NO.
INDU9TIt1AL
WASTE APPROVAL
OWNErS Imo'( - CHARGES
; 2 00
AUTHORIZATION TOTAL FFA CONN ION CH kRGE FE[
I HAVE AT THISDATE A CONTRACT WITH THE HEITEIN NAMED CON. REIMBURBEMENT FEE
TRACTOR TO CO NNECf THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC BEW[R. APPROVALS DATE INSPECTOR'S■ioM-URk
SIGNED T-H19 DAY OF 1D_
OWNER OR NEW H04S[SEWER
OWNERS AGENT CONNECT ADDITIONAL
ADDF{kBS BUILDINCO OR WORK
1 HEREBY ACKNOWLEDGE THAT I HAV; READ THIS APPLICATION SEPTIC TANK,SFV,PIT(B)
AND STAT[ THAT TH[ ABOVE IS CORRECT AND AGREE TO COMPLY AHD�OR DRAINFI[LD
WITH ALL COUNTY ORDINANCES AND STATE LAWS "OULATINO CESSPOOL ❑ DR
FLU MI,
AND BEWK". YWEL.L, ❑
1 HEREBY C[ATIFY THAM I AW "OPEFJL,Y REGISTERED AND/OR ALTER.REPAIR,BEWER OR
LI C[HBED AS REQUIRED BY LOS ANGLE) COUNTY AND BTAT[ OF SEWAGE DISPOSAL BYSTEM
CALIFORNIA OR THAT I A [ LEGAL OWNER OF, HD TO
REBID[ IN, TF1[ ADOV[ RI IID REB/ IAL P DISCONNECT PLUG ANO
1 ABANDON HOUSE SEWER
BIOF PERU BACKFILL aV IC TANKS ❑
BIE P,"m u Cus POOL)
ATION ROBERT A. WOOD
CK Y.O. CASH *W-gRVISING MECHANICAL ENGINEER
LfC0 3 0 7 1 ro DEC 3 1 0 n 5.0 0—