Loading...
HomeMy Public PortalAbout8756 GARIBALDI AVE_Sewer__ CESOS 6-66 75A 54LD APPLICATION FOR PERMIT ' COUNTY OF LOS ANGEISEWER-SEYVAG4 DISPOSAL D2PARTMENT OF COUNTY ENGW&ER BUELDING AND SAFETY DIMION BUILDING JOHN A.LAMB1 ,COMOLT En&eer ADDR[/" COLEMAN W. JENKINS,Sap t. of Building Ae LOCAL N EA R RBT FOR APPLICANT TO FILL INLEGAL DESCRIPTION LOT NO. .�7 OWNER rMAIL BLOCK TRACT O ADDRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. US[ OF BUILDING■ DISTRICT NO. GROUP MAPPROCLSSED BY /Q T DK PG CONTRA C-f0 10 I .--I- A 09W CONNECTION DATA TY TEL. NO. STATION D[FTH LI CF XSELICENSE �J N0. CLASS C S�� MANHOLE REFERENCE LOW[ NO. I DESCRIPTION OF WORK FEE TYPEDP ION L[NGIR FRUN HOUR[ SEWER CONNECTINS TO Y. F.L M.L TQ P.L PUBLIC SEWER 0 $ B.00 CO.IMP. NO. PNK, 3K91-AIRE PIT OR ,C.NO. IEPTIC TA .108 NO. SITS AND/OR DRAIXFIELD f �1 .00 � HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERLIT N :VK PRIVATE DISPOSAL SYSTEM / 111S.00 CONNKCT ADOMONAL BLDG. OR AFFIDAVIT •u R. ,IAlo[R RECORD.Ills".NO. DATE WORK TO HOUSE SEWER / $ 9.00 'ALTER, REPAIR OR ABANDON HOUSE SEWER OR DISPOSAL SYSTEM S $ 9.00 HWY.OR if.WIDENING [X T N,CESSPOOL, MANHOLE / Z 5.00 STATE ENCROACHMENT PERCOLATION TEST I $ 5.00 PERMIT NO. S INDUSTRIAL �E} a WASTE APPROVAL OWNERS PERMIT i 2 OO CHARGES CONNECTION CHARD[FE[ AUTHORIZATION TOTAI. FEE O 'I HAVE AT THIS DATE A CONTRACT W E HBREIN NAMED CON- REI M DU RSE M EM FEE TRAC`TORYO CONN[ THE ABOVE D DED APPROVALS a S TO TH[ PUBLIC'S APPROVALDATE INSPECTOR'S SIGH ii K SIGNED THIS *Y OF 1 OWN<R OR NEW HOUSE SEWER OWNERS AGENT CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.BEEF.PIT(a) 1 HEREBY ACKNOWLEDGE TP THAT 1 HAVE READ T14IN APPLICATION AND/OR DRAINFIFLD AND STAT[ THAT THE ABOVE I■ CORRECT AND AOR[[ TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING CESSPOOL ❑ bRYWELL El MIS AND NEW[RS. IAS CERTIFY TH I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR.SEWER OR LICENSED AS REQUIRE Y LOS ANGLJ� OUNTY D STATE OF S[WAd[PISFOSAL SYSTEM CALIFORNIA OR THAT M THE UAL OWNCER OF ND INTEND TO DISCONNECT PLUG AND RESIDE IN, THE A■ DESCR D R DIE ;? PK RTY ABANDON ANON HOUf[SEWER SIGNATURE BACKFILL/[FSC TANKS ElOF PERMITTEE SE[l.PIT(S) u FEBSPOOL. VALIDATION��)CK. M.O. 24222 JM 1 1 0 D 7,0 Q- q r