HomeMy Public PortalAbout8741 GARIBALDI AVE_Sewer__ .aa4; APPLICATION FOR PERMIT 1
DDIMON OF BUIMING AND SAFETY SEWER—SEWAGE DISPOSAL
Det of Coq a Engineer
Co=tT Of Low Angela BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
r
m C:ABHATT D. GRIFFIN, Sup-r or BUILDINo LOCALITY
FOR APPLICANT TO FILL IN CROS
ICS ST.
LEGAL W_ — oYXER
DESCR 1011 tOT X0. F r
AIL
R ,
BLOCK TRACT61 ADDRESS
' NO.OF SLDGS. CITY TEL. NO.
SIZE OF LOT "MOW ON LOT
USE OF
BUILDINGS DISTRICT NO. GROUP YAP
BK PG
CONTRACTOR
ADDRESS CONNECTION DATA
STATION DEPTH
CITT TEL N0. MANHOLE R11 CF UPPER
(� STATE LOWER
REGISTRATION NO. ❑ COUNTY
No. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING 70 TYPE 0 CON E ON LENGTH FROM
PUBLIC SEVER 3.50 Y, CURB P.L. Y.L.SO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD C. R0.
I
E TN.,CW POOL.DRYWELL LIIANHOLE 2.00 CO. IMP.N0, B NO.
I HOUSE SEWER CONNECTING TO
I PRIVATE DISPOSAL SYSTEM :1.00 TRUNK nRYR NO. PERMIT NO.
ONNECT ADDITIONAL BLDG.OR STATE ENCROACHMEXT .
WORK To HOUSE BEWER Q $1.00 PES IT X0.
ALTER,REPAIR OR ABANDON 14OUSE ' INDUSTRIAL
SEWER OR DISPOSAL SYSTEM s 1.0D WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNEE'8 REIMBURSEMENT FEE s 1 00
ADTHOHIZATIONIZOT!umFh -
I HAVE AT THIS DATE A CONTRACT •ITN THE HEREIN IIAMED CON- APPROVALS DATE 111SPFLCTOR•391G.XATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED IETING 7�1 ELI,ING
TO THE PUBLIC SEWER. NEW HOU-99 SEWER
SIGNED THIR SAY OF 19 CONNECT ADDITIONAL
OWNER OR - BUILDING OR WORK -
OWNERS -AGXXT
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AAD/OR DRAINFIELD
I "
TOWLEDGE THAT I HAVE READ T1,113 APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 13 CORRECT AND AGREI TO COMPLY
WITH ALL COUNTY ORDINANCO AAD STNTE LADS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I,HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AMD/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AN THE LEGAL ER OF THE ABOVE
DESCRIBED RESIDENT1.41. PROPERTY. BffILL SEPTIC TANS❑
SIGNATURE � S�.PIT'S) ElCESSPOOLS Q
OF PERMITTEE
JOHN A. L.AMBIE.COUNTY F:NnvrqprwR VALIDATI ROBERT A.WOOD. CHIJEF PLOD. INSPIK=OR
CjL a.
2 61 1I; SU24 4 2.00 2