HomeMy Public PortalAbout8761 GARIBALDI AVE_Sewer__ CTwe4[D
6AS42D APPLICATION FOR PERMIT
coIIHTY OF LOS RTMANGELES
SEWER—SEWAGE DISPOSAL
DEPAENT OF COUNTY ENGIDIEEH
BUILDING AND SAFETY DIVISION FD —
VrELJI"
JOHN A. LAM M Comm Eyyin/w
A. JENSEN, 9ap'E of Daf1d>nq
San (Ighp--rialN EA
EAREST
. Muscatel
tJ/
D[fCRIFTION LOT NO. OWNER
MAIL -235 Hill. Green Pl.
/LOCK TRACT ADDR[.BS
NO. br, BLDG/.
SIZE Or LOT N ON LOT CITY TEL.
U/[ OF NO -
04
BUDN
ILIGS DISTRICT NO. GROUP MAP PROCESSED RY
rJ SDK FO
CONTRACTORiqnlg _ -L 14-
ADDREIS 2315 118st COHNEc'
CITY L. A,TEL NoUj -6-4608 STATION DEPTH y"
RAT[ ! UPPER
REGISTRATION NO. '19099 H
COUNTY MANHOLE REFERENCE
NO. DESCRIPTION OF WORK FEE TYPE OF COIINEOTION LENGTH FROM
HOLIBE SEWER CONNECTING TO CURB P.L Y.L.TO P.L
PUBLIC SIW[R 0 SD.00 F.C.NQ.
R
SEPTIC YANK,BEEPA E FIT OR CO.IMP.NO. JOB NO.
FITS AND/OR DAI N F I ELD 0 110.00
HOUR[■ ER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO.
PRIVATE DISPOSAL SYSTEM $3.00
CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I /AI7n I kAM[ RECORD,INSTR.NO. DkTK
WORK TO HOU■E/EWER 53.00
OVERFLOW SQ■PAG[PIT,DRAINFIELD
KX7-N-CEDSPOOLDRYWELL-.MANHOLE 95.00
AL R.R PAIR A DON"OustHWM•OR ST.WID[NI NG
E
SWER OR P
DISPOSAL SYSTEM 33.00 STAT[ENCROACHMENT
PERMIT NO.
INDUSTRIAL
� WALT[APPROVAL
Q V��INM�$ PERMIT s 2 00 GHAROU
AUTHOR ATION TOTAL FEE CONNECTION CHARGE FE[
I HAVE AT THIS DAT[ A CONTRACT WITH THE HEREIN NA ED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED m(ISTING DWELLING To T�
TD THE PUBLIC ■EI1
WER. 3movp1s DATY IH ECTOR'■SIGNATURE
SIGNED THIS DAY OF. 19_
OWNER OR � NEW HOUR[SEWER
OWNERS AG[��
CONNECT ADDITIONAL
ADDRESS_ _ 1 BUILDING OR WORK
SEPTIC TANK.SEEP,PIT(9)
1 HEREBY ACKNOWLEDGE THAT I /HAVE READ THIS APPLICATION AND/OR DRAINFIELD
AND /TATE THAT THE ABOVE IS CORRECT AND AOR[[ TO COMPLY
WITH ALL COUNTY ORDINA NCEB AND STATE LAWS R[GU LAT NO
FLU Me ING AND SEWERS. CESSPOOL ❑ DRYWELL ❑
1 HER CRY CERTIFY 71-AT I AM PROPERLY R[GI/TE ALTER.AND/OR ALTREPAIR.SEWER OR
LICENSED AS REQUIRED BY LOB ANGLED COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I A11 THE LEGAL OWNER OF, AND INTEND TO DISCONNECT PLUG AND
RESIDE IN, THE A RISER RESIDENTIAL FR [RTY. ABANDON HOUSE SCW[R
SIGNATURE
OF FERMI'ITQ BACKFILL/[PUC TANKS ❑
QEEF.Prr(■) LI CISSPOOLJ El
VAMATIO� ROBERT A. WOOD
CK. M.O.
SUPERVISING MECHANICAL ENGINEER
CASH
LAL10 2 7 2 5:a APR 1 1 0 1