HomeMy Public PortalAbout9046 GARIBALDI AVE_Sewer__ APPLICATION FOR PERMIT 1
4eeDIVISION OF BUII.DING AND SAFETY SEWER----SEWAGE DISPOSAL
D.pa=tm at of CoanlT MW.&w
County of Los A "Im MCR;OS"SST.
JOHN A. LAMBIE, CouNTY ENGINEER
m CASSATT D.GRIFFIN, 8UP'T OF BUILDING
61
FOOlc LEGAL
DESCRIPTION LOT K0. i4 V
MAIL
BLOCK TRACT ADDRESS /0 age
R0. OF QLDGS. CITYTfL, KO
91;11 OF LOT NOW ON LOT
USE
BUILDINGS DDISTRICT NO. GROUP WAP
B[ PG
CONTRACTOR
ADDRESS A,,,s�P '�'9 CONN=ON DATA .
r STATIONp H
CI TEL. 11D /i �� YIUIHOLE R EXCE. - UPPER-
STATE
KO, �„ � - 7` �❑ COUNTLOWER
Y
i
No, DE,SCIZIPTION OF WORK FE><
HOUSE SE'W CONNECTING
COXXECT]OX LENGTH FROM
PUB IC SEWER B f S.SO Y, CURB P.L. Y.L.TO P.L. J
EPT�C�7Af1[,SERFAGE PI OR
PITS D/OR DRAIXFIELD 5.00
OVERFLOW SE±PArE PIt,DRAINFIELD P. C. N0.
EXTN„CES"COL,DRYWELL MANHOLE L.00 CO. Imp.N0. JOB NO.'
HOUSE SEWER-COKNECTIKQ TO
21VATS DISPOSAL SY37aX 1.00 TRUNK PERYIT�KO. ROAD PERMIT NO. 0
CQXNECT ADDITIO AL BLDG.OR STATE ENCROACHMENT
WORK TO (5usa ESV @ S 1,00 PERMIT XO_
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM 8 1.00 WASTE APPROVAL
C�C7
WAR GES
CONNECTION CHARGE'FEE
O�IVNEH`SPMMIT !L
AUTHORIZATIONTOTAL zo
BD REIIIBURSBMEPIT FEE /VEWHOZ)sr- yp 04 CSlPL
I HAVE AT THIS DATE A CONTRACT WITH 714EHEFiE1N NAMED COX- APPHOVXS DATE INSPECTOR'BBIGNATURE -
TRACTOR TO OQNNECT THE ABOVE DESCRIBED,UI$TIMQ DWELLING
TO THE PUBLIC SEWER. KED' DOUSE SEWER
STGNEq T}II A 1ST CONNECT ADDITIONAL;
OWNER OR BUI IKG OR WORK _
OvrXEJM& AG SEFTI C TANK,SEEP,PIT(3)
ADDR AND/OR DRAT FIELD -
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI ION CESSPOOL❑ DRYWELL❑ -
AND STATE THAT THg ABQVE 13 CORRECT AMD AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND S"ERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTLFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICXSEb AS REQUIRED BY LOS ANGELErS COUNTY AND STATE OF ,ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AY THE LEGAL OWNER OF THE ABOVE _
DESCRIBED RESIDE TIhL PROP $ PLL(SSEPT❑IC TAS LS❑
al➢NAiuRE
OF PERMI {
JOHN A.t,kMBIE.CouNTY ENGINHEIR ALMATION ROBERT A.WOOD, CHIKP•PL.BG. INSP[ OFt
. � Ill..o_ CRIBGT
a A 5 J 2 5 .0 ti
s°A&4 °
•r wuttse APPLICATION FOR PERMIT
DrMON OF BUILDING AND SAFETY SEWER-SEWAGE D 1 S POSA L
Deparb-mut of Cotmt7 E-gh" a
Coontr of Los Angel BUILDING
JOHN A.LAMBIE, COUNTY ENGINEER ADDREM
T CASStSATT D.GiRII-71N, HUr•T OF DOtLmNo LOCALITY Fle
RAREST
OR APPLI O CROSS ST.
LEGAL
DESCRIPTION LOT n0. OTN�
■AIL
BLOCK TRACT ' 'QO�' ADDRESS
NO.OF BLDGS. CITY TfiL X
SIZE OF LOT NOW On LOT
BUIUSELDINGS
OF DISTRICT NO. GROUP NAP
CONTRACTOR CT BK '�
COlNTRACTOR � a
ADDRESS COMUC'T1ON DA7A
STATION D DEPTH .�
CITY L. n0 D
MANHOLE REFERENCE
ty
.( ATE �� �'✓
REGISTRATION NO. 97-1 ❑ COUXTY
No. I DESCRIFTI N OF WORK FEE E o MECT1On LENGTH FROM
HOUSE SEVER CONNECTING TO Y. CUSB P.L. Y.L.TO P.L.
PUBLIC SEWER IR 3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q 3.00
OVERFLOW StEPAGE PIT,DRAINFIELDP. C, NO. _
EKTN.,CESSPOOL,DRYWELL MANHOLE 2.00 CO. IMP• n0. JOB N0.
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM Q $1.00 TIIUnr PERMIT NO. ---' ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER Q f 1.00 PERMIT NO.
ALTER%REPAIR OR ABINDON HOUSE INDUSTRIAL -
SEWER OR DISPOSAL HYSTE _ 1.00 WASTE APPROVAL -
CHAR G ES
CONVECTION CHARGE FEE /
OWNER'S pEabUT S 1 00 REIMBURSEMENT FEE /�
AUTHORMATION TOTAL FEE
1 SAYE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED COX- APPROVALS PATE INSPECTOR'SSIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEINER
SIGNED THIS 19 CONNECT ADDITIONAL
OWNEERI,//OR BUILDING OR WORK -
OWXEY9-'AGEXT SEPTIC TANK,SEEP,PIT(3)
AbDRES AND/OR DRAINFIELD
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 DISPOSAL SYSTEM
I HEREBY CERTIFY THAT IA PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HODS EWER
CALIFORNIA OR THAT 1 AN THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL P OPERTY. BACKFILL SEPTIC TANKS C]SEEP.PIT(S) ❑ CESSPOOLS C3SIGNATUREdd=LC -
OF PERMIT.- L
JOHN A. LAMBIE, COLIN EN6INEISR VALIDATION ROBERT A.WOOD, CHIIIIT PL,160. 1 PECTOR