HomeMy Public PortalAbout8865 GARIBALDI AVE_Sewer__ 7esE4: -94 ' 'APPLIC ION FOR PERMIT S f
COUNTY of LOS ANGELES SEW R-SEWAGE OSAL
DEPARTMENT OF COUNTY ENGUCM
BUILDING AND SAFETY DIVISION BUILDING
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LOCALITY
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FOR APPLICANT TO FILL INLEGAL
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MAIL
BLOCK TRACT ADDR[l
I NO. F BLDGS.
Sim or LOT NOW ON LOT CITY TEL. No.
US[ OF A
DISTRICT NO. GROUP , MP tY
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CONTRACTOR J
ADDRESS fCO CTION DATA
r I STATION �a—D DEPTH
C fTY TEL. STATE
N
REGISTRATION NO. (/y/ COUNTY MANHOLE R[FOI[NC[
{ LOWER
NO. DESCRIPTION OF WORK FEE TYPE or CONN[C.TION LEN TH FR
HOUSE■[WLR CONNECT7No TO Y. CURB P.L. Y.L.TO P.
PU■LIC SEWLR f8.00
P.0 NO.
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PIT/AND/OR DMINFIELD � 510.00
HOUSE■ CONNECTING TO TRUNK PERMIT NO. ROAD PEJU(IT NO. O
0
PRIVATE DISPOSAL SYSTEM 13.00
CO ADDITIONALAFFIDAVIT wArvlL L� RNM RECORD,IN■TR,NO. DATE CA
WORK TO HOU■L/EWER ■1.00 0
OVERFLOW B EPAG F DRA N ILLD
[XTN„CEASPOOL,DRYWELL.MANHOLE 41 S5.00 HWY.OR ST.WIDENING
SEWER OR DIAPCWAI,SYSTEM $3.00 D.
/TATE ENCROACHMENT �
^ r PERMIT NO. Z
INDUSTRIAL
WASTE APPROVAL
CHARGES
OwNms t z 00
CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE
'I HAVE AT THIS DATE A CQNTRACT WITH THE HEREIN NAMED CON. REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ASO VE D[1CRIBig
TO THE PUBLIC BEWLR. AMOVAM DATE IH R'A■IG URL
O1GNQD THIS
OWNER OR NEW HOUSE■}tiYER J'
OWNERS AORMT CONNECT ADDITIONAL
Of BUILDING OR WORK
ADDRESS
/LPTIC TANK,”"PIT(S)
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND/oR DfMINF1ELD
AND STAT[ THAT THE ABOVE I■ CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINAN CU AND STATE LAWS REGULATING
PLUMBING AND /EWERS. CX"POOL, ❑ DRYW[LL ❑
I HEREBY CERTIFY THAT 1 PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED Al RIOUI BY ANGLE/ CO AND TI OF SEWAGE DISPOSAL SY/T[M
CALIFORNIA M [ GAL OWN O AN I T DISCONNECT PLUG AND
RLSID[ IN [ V[ D R[ll PRO ABANDON HOUSE/EWER
f
SIGMA • KFILL SEPTIC TANK/ ❑
SEEP.PIT(S) Li CIlSPOO LS
01 `/ ATIO R BERT A. WOOD
CK. M.o. CASH SUPERVISING MECHANICAL ENGINEER
LA.o 12 Es FEB 15 1 0 D 5�,O Q,-
fl' Via:
-77 C)
C[AOS 15-US
7eAe.t2D APPLICATION FOR PERMIT
COUNTY OF LOS ANGM- SEWER—SEWAGE DISPOSAL
DM?ARTMENT OF COUNTY ENGMEM
BUELDING AND SAFETY DIVISION BU IL,DING
JOHN A.L.AMBIE, County Engineer A10DRub j�Sf
COLEkUN W. JENLINS,Sap t. .I Building
LOCALITY
N R
FOR APPLICANT TO FlU IN CROSS ST'
LKOAL
DESCRIPTION LOT NO. OWNL11 H� L
MAIL
■LOCK TRACT ADDRESS
NO. OF BLDOt.
SIZE OF LOT NOW OH LOT CITY TEL.-NO.
■U[LD HOS DISTRICT NO. GROUP MAP PROCESSED■Y
DK PO
CONTRACTOR
ADDRESS
CONNECTION DATA
CI TEL. NO.
STATION DEPTH
WLict NOC[ME[ CLA D>!SE
UPPER
/ ✓ MANHOLE REFERENCE
LOWER
No. DESCRIPTION OF WORK Fitz TYPE OF CONNECTION Luvon-L FROM
HOUR[ SEWER CONNECTING TO Y. CURB P.L M.L.TO P.L.
PUB-LIC SEWER • S 6.00
P.C.NO.
PITS AND/OR DRAINFI[LD 1 $1 0.00 CO.IMF.NR. JOS NO. /�'{►
HOUSE SEWER CONNECTINS TO TRUNK PERMIT NO. ROAD PERMIT NO. �J
PRIVATE DI SP06AL SYSTEM 1 S 5.00
AFFIDAVIT WAITER [AIKY[[T RECORD.INSTR.HO. DATE
WORK TO HOUSE SEWER S $UUaff
i
1EW[R ^a '��•�^••� • 5.00
H WY. OR ST.WIDENING
EJ(TN.,C[11 POOL, MANNOSE 1 9 6.00 STATE[NCROA HMENT
PERCOLATION T46T / 111 6.00 PERMIT NO.
iNDUITRIAL
WAST[APPROVAL
CHARGES
OVR'UM S PERMrT s 21 00
AUTHORMATION TOTAL, FM CONNECTION CHARGE F[E
URIIEMENT FE[
R
'I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- REIM'
TACTOR TO CONNECT THE ABOVE D[SCRrs[b ]LISTING DW[LLIHO
TO THE PUBLIC 1 [ APPROVALS DATE INSPECTOR'S 9 1 NATU RE
SIGNED TW19 AY OF
OWNER OR NEW HOUSE SEWER
OW N[RS AG[ 40NNECT ADDITIONAL
BUILDING OR WORK
ADDRESS
SEPTIC TANK.BEEP,PIT(S)
I H[1R[EY KHOWL[DGf, THAT 1 HAVE 14EAD THIS APPLICATION AND/OR DRAINFI[LD
AND STATE THAT THE ABOVE IS COftR[CT AND AOR[[ TO COMPLY
WITH ALL COUNTY ORDINANCES AND RTATE LAWS REGULATING SPOOL ❑ DRYW ELL ❑
P L UYI RING AND BEW QRS. C✓B
I HEREBY CERTIFY THAT I AM PROPERLY REOISTER<D AND/OR ALTER,REPAIR,SEWER OR
LICENSED AB REQU1R[D BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM TH [GAL OWNER OF, AND I ND TQ DFBCONNECT PLUG ♦ND ✓�
RESIDE IN, THE ABOVE DES ED R[ ID TIAL PROP A6A}IDON HOUf[E[WER
SIGNATURE
F
OF FRM BACKFILL SEP�IC TANKSNAME ❑
PERMITTEE SEEP,PUT(8) LI CESSPOOLS
AIMATION
CIC. M.O. CASH
a LEc27 1 0 0