HomeMy Public PortalAbout9055 GARIBALDI AVE_Sewer__ 7— Sri,
APPLICATION FOR PERMIT
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DIMON OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Dopmtn@W of Cam Enyia«r
Caom17 of Las kV.
a a. BUFL.DIN% ::j
wm.J. FOX, COUNTY HNOINSOIII DDRL2Z
CA"ATT D.GRIF]".SUPT OF■URMrH6 LOCALMFOR APPLICANT TO FILL IN NEAREST
LXGAA]]. F JCROSS ST.
DESCRIPTION LOT NO. Fv %5 +.+ OrwY�BLOCK TRACT 0 PAIL
(�' DDRESS
SIZE OF LOT . � b NOM ON LOTS CfTY ' d Tyl- No. AT USE OFBUILDINGS DISTRICT NO. GROUP Y■K
CONTkACTOR (p r`91 40 0
ADDRESS '`� COM=ON DATA
CITY--t—e— TEL.NO. STATiO DEPTH
WYTATY MANHOLE/4REYEAENCK LOMER
RKGISTRATION NO. UPPER
LENGTH FROM
no. DESCRIPTION OF WORK FEE Y CURB Y.L.TO P.L Q
HOUSE SEER CONNEfTIRO TO / A
PUBLIC E ER SAO
HOUSE SEWER CONNECTING TO { ,
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR Q a CO. INP.NO. JOS
WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING -NUNC PERMIT NO. DAD PERMIT
SEWER OR DISPOSAL SYSTEM 1.00
DISCOWtECT AND ABAN X Z-{WER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL oo
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ORLY 2.00 CHARGES
PERMrrCONRYCTI O GE FEE '
OWl��s $ 1 00
y
AUMO14TION TOTAL F•� J- R I SkYENT FEY '
I HAVE THIS DATE CONTRACTED WITH THEHEREIN NAMED COR- 4
TRACTOR TO CONNECT THS ABOVS Df3CRIBE7C111TIA9 pWEL(_IXG APPgOYALB DAT$ INSPECTOR'S SIGNATURE
TO THE PUBLIC BEWIER -
- RbY ROUSE fLyYR
SIGNED THIS SAY
OF—CONNECT ADDmONAL
OW ERS BUILDING OR WORK
ER! AG
ADDRESS AND IORSEPITCTDRAINFAPUK FIIELbPIT(t)
I HEREBY ACXKOWLEDGI THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVEI-12-CORRECT AND A9RIiX TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR SEWER OR
PLUMBING AND SEWERS. _ SEWAGS.DISPO AL SYITEI
1HEREBY CERTIFY THAT I AM PROPERLY REGISTIItH AHD/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AN ATG OF DISCONNECT PLUG AND
CAWTfORNIA OR THAT 1 AN -THE LEGAL ABOVE ABANDON HOUSE fiWKR
DESCRIBED RYSIDKIiTIAL XRTY. BACKFILL C TARNS
SKEI.
AT
SIGIIATURE
OF mldl
WILIJ"J. FOX.GO OILLIZIER 4A2fDAllbN
�&4 2 7 8E 2 4 2.0-0 a
fY
BY _
DEPUTY DEPUTY
BY Byfj
m DEPUTY UTT
'°""=DAPPLI•CATIOWF'OR PERMIT 1
i"S 12-a4
DIMION OF BOII.DING AND SAFETY SEWER—SEWAGE DISPOSAL
D.p=m@W of ComityF�ytn..r
Com of Los AaQ�]K BUILDING
WM.J. FOX, COUNTY SNGINzmt ADDRESS
CASSIATT D.GRIFFIN,turT of■UILDLH• LOCALITY
FOR CANT TO FUl IN NEAREST
CROSS ST. ClZrg
LEGAL
DESCRIPTION OT ,OWNER
BLOCK TRACT MAIL
ADDRK"
NO. OF BLDG$.
SIZE OF LAT NOW ON LOT CITY
USE OF a
BUILDINGS DISTENCT NO. GROUPI o
YAP
CONTRACTOR _r '
BK G
ADDRESS v CORRECTION DATA
CITY / TEL A44 Z;z 2f STATION 7L2 Z♦ DEPTH
STATE I YA4HO RGFERENCI[
REGISTRATION NO. COUNTY CS L
no 5� TYF RECTION LENGTH FROM
No. DESCRIPTION OF WORK FEE Y. CUR P.L. Y.L.TO P.L.
HOUSE SEWER C NXECTING
PUBLIC SEWER 3.150
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT AbDITIONAL BLDG. OR CO. INP. NO. "z JOB. NO.
nq
WORK TO HOUSE SEWER 1.0.0
ALTER OR REPAIR EXISTING•
SEWER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD P[RNIT NO. r/
DISCONNECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPpOL- DRY-WELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 CHARGES .
CONNECTIOR CHARGE FEE
OWNSE'S PEEbuT a 1 00
AUMOEIZATION TOTAL FEEI HAVE DATE CONCTED WITH THE REIMBURSEMENT F[[
NAMED CON-
TRACTORTTOSCONNECT THEABOVE D"CRIBEDH"IESTIXG PWELLNG AMOYAIS DATE INSPECTOR'S SIGNATURE
TO THE P9BLIC SEWER
SIGNED THIS 212 DAY OF 19,4 NEW HOUSE SEWER
OWNiR Oh CONNECT ADDITIONAL
OWNERS 14772� ✓ BUILDING OR WORK
SEPTIC TAN[, SEEP PIT($)
ADDRESS
AND/OR DRAINFIELb
I HEREBY,ACENOWL.EDGE THAT 1 HAVE READ THIS APPLICATION CWPOOL❑ DRYWELL
AN-0 STATE THAT THE ABOVE 1$ CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER, REPAIR SEWER OR
PLUMPING AND 64WERS. SEWAGE DISPO'4AL SYSTEM
1 HEREBY CERTIFY TIIAT 1 AY PROPERLY REGISTERED AND/OR
LICENSED AS REOUIRED BY LOS ANGELES COUNTY D STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT 1 AN THE LEGAL OWN OF TH[ ABO'[ ABANDON HOUSE SEWER
DESCRIBED RISIBEYTIAL P PEATY. BACKFILLm$1 [f 0qCTA C7
REEF S
ilIGNATURE
OF PERMITI
WILJ_IAM J. FOX, Cou Glrtmk ATION
.� _T,a:If 4 6r M 1 4 450 0
DEPUTT DEPUTY
BY ST
m D[PUTTDEPUTY