HomeMy Public PortalAbout9115 GARIBALDI AVE_Sewer__ baFa"it-so APPLICATION FOR PERMIT
DMMON OF 13UMDING AND SAFETY SEWER—SEWAGE DISPOSAL
Dep-ft-at of County EngUmm
C=,ay of Los An"I s bUILDIXs // 5" l�/q/4/$�Lg/ A ✓E
JOHN A. LAFIBIE,COUNTY ENOINYSR ADDED r
CABdATT D.GRIFFIN, SUPT OF BUILDINO L14L1TY '! EMP {,�1 7-
Fll�� FOI APPLICANT TO FILL IN MAR .4 7`"E
D GRIPTIOi LOT NO. .Z--Z — ., b 0 FT. �h>� 4 A MA
9LOCK //TRACT O +� ADI) 9 l/S G� LD� ?pv�p.' .
SIMOP LOT �Il /Z17 NOW ON LOTNO.OF S /�_ 7! J p
UDE 0
BLILD NGS .Car— ctATI
SMCT O. GROUP�*'� YAP
BIC PO
CONTRACTOR
CONNECTION DATA
ADDRESS
STATION DEIPTH
CITY TEL. No. ROLE RUMEN CE _ � UPPER
❑ SLOWER
REGISTRATION NO. ❑ C
No- DESCRIBTION OF WORK FEE
HOUSE 9 CONNECTING 70 TTP[OF tohmrz T GT'H FpON
PUBLIC SEM'£R 3.50
CURB L. Y.L TO.P.L.SEPTICTANk,SEEP GE P OR
PITS AXD ORD IX�IELD ® ;3.00OVERFLOW BEEPAGEPIT,DRAINFIELD C. NO.
EXTX.,CESSPOOLDRYWELL YANMP. N0, J 0.
HOUSESCONNECTINQ TO
PRIV TE IDPOS L SYSTE 1.00I PERMI ROAD EAMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE MXCR CHYENT
WORK TQ HOUSE 3 ER Q ;I.go PERMN
Atl'RRrQ,GP4i"R ABANDON HOUSE INPUSTRI L
Sii�R+BR DI SAL APEY ® 1.00 WASTE APPROVAL
C HAR G ES
'CONNECTION CHARGE FEE "
OWNER'S PERMIT s t 00
UTHOREZATIOv TOTAL FEE
REIYBU SEYSNT FE■Ftf n
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN HAYED CCN- APPROVALS DATE. INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE "OH DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWERNEW HOUSE SEWER -
SIGNED TNISJJ Y OF 19: CONNECT ADDITIONAL
OWNER OR /� BUILDING OR WOR
SEPTIC TANK,SUP,PIT{S)
ADDRES • AX-D/CR DRAINFIELD '
I HEREBY AGKN LEDGE THAT I HAVE READ THIS APPLICATION
ggpOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND A-GREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEVER OR
PLUMBING AND SEWERS. SEWGE DISPOSAL VSTEM
1 HEREBY CERTIFY THAT I AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG
LICENSED AS REQUIRED BY LOS AXBELFA COUNTY AND STATE OF g AND
XDOX HOU USE CALIFORNIA OR THAT J AY THE LEGAL OWNER OF THK ABOVE ,fi
EWER
DESCRIBED RESIDENTIAL OP TY, BACKFILL SEPTIC TAJIKS�E
VIGNATURE SEEP.PIT(S)I0 CESfPOL7
O ",
OF PERMITTEE -
JOHN A. LAMBIE, COUNTY ENGINEER VAUDATIQN ROBERT .W QD, CHI KF`FLERe. INSPECTOR
;107 8 8 4 rill'! 6 4. 2.30