HomeMy Public PortalAbout9061 GARIBALDI AVE_Sewer__ 7SA64zD APPLICATION FOR PERMIT
eAe4
COUNTY of ros ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION eu1LDINa ba Ld- r
vvmOHlf A T.I1f11T}. Cc= En SBr ADDR6fl
l k. I>;x l SUP7 af $'nuildinv
LOCALITY
K EARSST
FOR APPLICANT TO FILL IN `ROSS f.
DtftRIPTGAL
IOH LOT NO. OWNER
Q
MAIL(LOCK �- T O ADDRESS
A NO. OF BLDG S.
BIZ[ OF LOT /� HOW ON LOT CITY TEL. MO.US[ OF DISTRICT NO. GROUP MAP PROC[Sl[D n
BUILDING■
yf�j ■K PG
CONTRACT /�/' S!vc (J y t
ADDRurJS CONNECTION DATA
CITYrl TEL. NO. 93, 3
STATION lo DEPTH
R' � MANHOLE REFIRENC[ /
REGISTRATION HO. ��dV COUNTY
NO. DESCRIPTION OF WORK FI[ TYPE OF IONLENGTH FROM
CT /
HOUSE SEWER CONNECTING TO Y. ■ P.L. M.L.TO P.L
PUBLIC■EWER jB.00 P.C.NO. )-
S C A CO,IMP,NO. JO■NO. D-
PITS
AILD/OR DRAINFIELD 810.00 O
NOUS[■EWER CONNECTING ER
TO TRUNK PERMIT NO. ROAD PfAMIT NO. U
PRIVATE DISPOSAL SYSTEM 47.00
CONN[ ADDITIONAL■ .O AFFIDAVIT ■AA[[ W[Y[/f} RECORD.INS".NO. DATE O
WORK TO HOUSE S[WIR $3.00
S
OV[RFLQW L
[EPAO[PIT,DRAINFI[ D
KXTN.,CESSPOOL,DRYW[LL.MANHOLE, 85.00
AL R A HWY.OR R.WIDENING
SEWER OR DISPOSAL SYSTEM 41 K3m0O STATE ENCROACH tNr
PERMIT NO, Z
INDUSTRIAL
WAST[APPROVAL
GHAROV
OWNER'S PEEWT $ x 00
AUTHORIZATION TOTAL. FEE CONNECTION CHARD[FII
'I HAY[ AT THIS DATE A CONTRACT WITH THE HEREIN MAMIDD CON• R[IMSURSEMENT ME
TRACTOR TO CONNECT TH[ ABOVE D[SCRt I0[D GLIfTIN0 DW[CLING l
TO THE PUBLIC SEWER. APPROVALS DATE INSP[CTCTR'S SIGNATURE
SIGNED THIS DAY OF 19_ + J
OWNER 0A NEW HOUSE S[W[R
OWNERS AGE NT
^ CONNECT ADDITIONAL
SU ILDING OR WORK
ADDRIfS
■EFT IC TANK,2EIP,PITS)
�I I HERESY ACKNOWLEDGE THAT I HAVE READ TRHlf APPLICATION AHD/OR DRAINFIELD
AND STATE THAT THE A■OVI If CORRECT AND AGR. TO COMPLY
WITH ALL COUNTY 0RDIHANCV
AND STATE LAWS RIOULATING
PLUMBING AND SEWERS. CESSPOOL ❑ DRYWILL ❑
I HERESY CERTIFY THAT I AM PROPERLY R[OIfTER<D AHD/OR ALTER.REPAIR,SEWER OR
LICENSED AS REQUIRED ■Y LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT I AM T LEGAL OWNER OF, AND NT[N DISCONNECT PLUG AND
RES ID[ IN, THI ABOVE ■tD ID[HTIAL PROP ABANDON HOUSE SEWER
S ITURK
O FAFERMI BAC KRILL SKI I( TANKS ❑ j�_
SES.Prr(f) u CESSPOOLS �' 7
vg
M.O. CASHATION ROBERT A. W D
SUPERVISING MECHANICAL ENGINEER
LAL;ol 8 9 3NOV271 u D 7,00~
I
I "