HomeMy Public PortalAbout9118 GARIBALDI AVE_Sewer__ BA5410-e'J
7eAe42D APPLICATION FOR PERMIT
�1
COUNTY OF LAS ANGEIM SEWER-SEWAGE DISPOSAL
Dt`PARTMMI T OF COUNTY ENGINEER
BUELDING AND SAFETY DIVISION ■u ILDINo
VpII.LIll1tA IIM. 8up'E of M.
LOCAkITY '
NEAREST
FOR APPLICLOV TO FILL IN CROSS .T.
DESCRIPTION LOT NO. OWNER
MAIL
ADDRESS _T
BLOCK TRACT
NO. OF ■ s.
SIZE OF LOT HOW OH LOT I C TEL. NO.
US[ OF DISTRICT NO. GROUR MAP PROCU/[D SY
IllUILDINGf ■K PO
CD ��- � .�- !o
ADDRW CONNECTION DATA
STATIPH
CITY I DEPTH
eTATIUPPER
R[0(ST RA COUNTY MANHOLE REFERENCE'
NO. DESCRIPTION OF WORK FI[ PE OF CONNECTION LENOTH FROM
HOUSE■EWER CONNECTING TO CURE P.L
PUBLIC 15E7W[R * •15.0-0 'r P.C.NO.
• C ANK,■ P GE PfT OR JO■NO. O
PITT ANDIOR D"NF..LD .10.00 CO.IMP.NO. } ()
HOUSE■EWER CONNECTING TO TRUNK PERMIT NO. ROAD PEr1WfT NO.1 �S o QC
PRIVATE DISPOSAL SYSTEM .7.00
CONNECT ADDITIONAL■LDC.Oh AFFIDAVIT I /.n[■ RECORD.IN TR.NO. DATE LjrVL�
WORK TO HOUSE SEWER $7.00
OVERFLOW SEEPAGE PIT.DRAINFIELO
EXTH..C[SSPOQL,DRYWELL.MANHOL[ .15.00
AL O A N O HW-
Y.OR JET.WID[NINO N
SEWER OR DISPOSAL SYSTEM $3.0.0 STAT[KNCROACHMKPCT
PERMIT NO.
INDUUTRIAL
WASTE APPROVAL
CHARGES
OWNER'S PMUCT s 200
CONNECTION CHARD[F[[
AUTHORIZATION TOTAL. FEF
'1 HAVE AT THIS DAT[ A CONTRACT WITH TH[ HEREIN N MED CON- REIMBURSEMENT f'II
TRACTOR TO CONNECT THL ABOVE DEI
SCRI15D LXI/TING DWELLING ■7�7� 1l a
TO THE PU■LIC SW[R. APPROVALS AT[ INSP[CTO R'//LONA R
[
SIGNED TH18 DAYpF 1fl_ ) '
OWNtR OR \ 1 NIE
W HOUSE/ WER / �—"-.Y i i .t•
OWNERS AGENT �\ CONNECT ADDITIONAL
BUILDING OR WORK
ADDRIS■ SEPTIC TANK.SER,PIT(/)
I H[RE■Y ACKNOW LIDO[ THAT I HAVE READ THIS APPLICATION AHD/OR DRAINFIELD
AND STAT[ THAT THE ASOVE I■ CORRICf AND AGREI TO COMPLY
WITH ALL COUNT' ORD INANC[1 AND STATE LAWS REGULATIM
LUMSING AND SEWERS. CESSPOOL ElDRYW[LL
PCl
I HERE■Y CERTIFR
Y AM "OPQILY R AN OR ALTER.REPAIR,SEWER OR
LICENSED AL REO ■ L6S ANO LEE CO A OF E[WAGE DISPOSAL/YSTEM
CA LIPORNIA OR I THE LEGAL QW NO TO DI/COHN[CT PLUG AND
RESIDE IN, THE V EDCRISED RU PRO ■E fEW[R
151ONATUR[ 15ACKFILL SSP[�C TANKS
OF P[RMI SEEP.PST C1) LJ CWPOOL/
ALIDATIO ROBERT A. WOOD
SUPERVISING MECHANICAL ENGINEER
CK. M.O. CASH
LA�05878;Z NOV131 0 D 7.00- 1"
7e aaoup -0a APPLICATION FOR PERMIT
COUNTY OF LOS ANGELES SEWER—SEWAGE DI POSAL
DtPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION ■u LDING
))Offif �
Co=tT EngbcL@&r ADDRSJS ►
VV1TJ IAM A Tom. SUp'4 Oi 3t1d-Q r�
LOCALITY
NEAREST
FOR APPLIC O IN CROSS
ST
DESCRIPTION LOT NO. wl OWNER
MAIL
ALOCK TRACT ADDRp■
NO. OF SLD S.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USK OF DISTRICT M0.1 GROUT MAP /"L n'
RU ILDINGS
■K PO
baez A�v
CONTRACTOR
ADDRL" ONNECTIO DATA
STATION DEPTH
C I � TEL
�` STATE UPT'[R
REGISTRATION NO. _X COUNTY MANHOL[R[FI RINC[ LOWER
No. I DESCRIPTION OF WORK FEEPYP[ F ONNECTION LENGTH FROM
HOUSE/EWER CONNECTING TO Y. CU P,L 0. M.L To P.L
PUBLIC/EWER + sm.00P.-NO.
S IC TANK, AOE TIT OR JOS NO.
PITS AND/OR DRAINFILLD 510.00 CO.1 O.
HOUE [ CE
R[SWRONNLCTINO TO TRUNK PERMIT NO. ROAD PERM rr N GL
PRIVATE DISPOSAL SYSTEM 57.00 O
CONNECT ADDITIONAL-BLDG.Ott =RIIC:>�NO.. AFFIDAVITE DAT
WORK TO HOUSE SEWER $3.00
OVERFLOW SLEPAO[PIT,DRAINFIELD
KXT►I.,C EI/SPO OLDRYW[LL,MANHOLE 0 515.00
AL IRO A DO HWY.OR/"f.WIDENING '111
z
Z
SEW[R OR DISPOSAL SYSTEM OR 1113.00 STAT[Oi CAOACHMCHT
FLRMIT NO,
INDUSTRIAL
WASTE APPROV
CHAROXS
OWNERS PERMIT $1 2 00
AUTHORIZATION TOTAL M CONNECTION CHAR.[FEE
'1 HAVE AT THIS DATE A CONTRACT WrrH THE HEREIN NAM® EE
CON- REIMBURSEMENT F
TRACTOR TO CONNECT THE ABOVE DESCRIBED LX IBTINO DWELLING R�7
TO THE PB
USLIC SEWER. APPROVALS DATE INSPECTOR'S ilONw l'U RE
810NED THEA DAY OF IG_
OWNER OR �/ NIfW HOUSE SEW"
OWNERS AGENT CONNECT ADDITIONAL
■U ILDYNO OR WORK
ADDRESS SEPTIC TANK.MEET,PIT(8)
I HEREBY ACKNOWLEDOL THAT I HAVE RER
AD THIS APPLICATION AND/OR DAI NFIELD
AND STATE THAT THEABOVE E
1■ CORRECT AND AOR[[ TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS RLOULATING
PLU Ma[NO AND S[WERf. CESSPOOL ❑ DRYWrLL ❑
I HERESY CERTIFY T 1 AM PROPERLY REGI ED AND/OR ALTER.REPAIR,/EWER OR
LIC[rIS[D Al R[OUI LOS ANOLp COUNTY AHD SUTI OP SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR TM M THE LEGAL MER O AND INTEND TO DISCONNECT PLUG AND
RAID[ IH, THE DESCRIBED R A PROP LATY. ABANDON HOUSE/EWER
SIGNATVRE BACKFILL(/LPTANKS ❑
OF P[RMI P,PIT ) l GESS POO LS
VALIDATION/1) ROBERT WOOD
CK- M.Q. '/]�'CA//H f"- SUPERVISING MECHANICAL ENGINEER
LA�o6097G NOV2310 D 5.0001
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