HomeMy Public PortalAbout9012 GARIBALDI AVE_Sewer__In, 4;711 De APPLICATION FOR PERMIT 1
DMISION OF BUILDING AND SAFETY SEWER—SEWAGE D I S POSA L
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County of Los Angels BUILDING
JOHN A. LAMBIE, CouNTY ENGINEER ADDRESS
i m CA$GATT D.GRIFFIN, SUPT OF EUILDINO LOCALITT
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OR APPLICANT 70 FILL IN �sr. -
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TRACT �Q ADDRESS-
27(OaA
N0.OR BLDG3.NO#ON LOT CITY � TEL. N0. tt
DISTRICT N0. GROUP MAP PG
CONTRACTOR740
ADDRESS COMU=ON DATA
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ST TION D
CITY •TE O
-OE oe IANHOLE$111ERENCE U
❑ STATE f ER
REGISTRATION 10. e, ❑ COUNTY
No. DESCRIPTION UF WORK FEE
HOUSE SEWER CONN-ECTING TO TTPQ OF ION _ - LENGTH FROM
`
PUBLIC SEWER 5.60 Y• QB P.L. .L TO P.L. J
3EPTIC TANK,SEEPAGE PIT OR - ti
PITS AND/OR DRAINFIELD 3,00
OVERFLOW SE"AGE PIT,DRAtNF1ELD CO. IIP N0, JOB NO
i EXTN.,CE33POOL,DRYWELL MANHOLE 2,00
i HOUSE SEWER CONNECTING TO ,
i PRIVATE DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO, ROAD PERMIT N0.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q =1.00 - PERMIT N0.
ALTER,REPAIR OR ABANDON HOUS -
HEWER OR DISPOSAL SYST Y @ 1.00 INDUSTRIAL
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE'
OWNERS PERMIT i 1 00
AUTHORIZATION TOTAL FEE REIMBUR3EVENT FEE fY� f/UUf� �o aLD L'S�'PL
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN RAYED CON- APPHOVAIS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWE NEW HOUSE SOWERi
SIGNED TFU AY OF 19 15•S
CONNECT ADDITIONAL
OWNER OR /1 BLLLDIXG OR WORK
OWNERS AGENT ` OL` SEPTIC TANK,SEEP, PIT(S)
ADDRES AND/OR DRAINFI LD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE •IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE PISROSAL"STEM
IHEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES CO AND STATE OF DISCONNECT PLUG AND 7
CALIFORNIA OR THAT 1 AN THE GAL ER OF THE ABOV ABANDON HOUSE SEWER
DESCRIBED RESIDENTIAL RT-Y1 SEPTIC TANKS El
SIGNATURE SEEP. PIT(3) ❑ CESSPOOLS
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER Vnr.mAT1O ROBERT A.WOOD, CHIEF PLBG. INSPECTOR
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