HomeMy Public PortalAbout9163 GARIBALDI AVE_Sewer__ DEPAKITIMiT OF COUNTY ENCUNIUM SSR-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
OOUNTY OF LOS ANGM,
WILLIAJ. FOX, COUNTY ENUINEIR I BUILDING
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REGISTRATION N0. COUNTY ROAD PERMIT NO.
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT M0. PERMIT NO.
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WASTE APPROVAL
SIZE OF LOT �//y /N0.OF BL
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NO. DESCRIPTION OF WORK FEE
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/ HOUSE SEWER CONNECTING TO
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PUB LID SEWER ! Lzo RECEIPT NO. DATE BY
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PRIVATE DISPOSAL SYSTEM I.00
6UN-NECY ADDITIONAL B eL ORE N RECORDED
WORK TO HOUSE SEWER 1.00
ALTER 6A REPAIR NO ATQ BY
SEWER OR DISPOSAL SYSTEM I.00
b[SCONN901 Amb ABANDON SEWER
AMD OR DISPOSAL BYSTEY 1.04 CONNECTION DATA
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BPE0IAL CONDITIONS ONLY ZOO / )) MANHOLE REFERENCE
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TYPE OF CONNECTIONP.L M.L TO P.L
LENGTH FROM
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OWNERS PERMIT ; I 00
AUTHORIZATION TOTAL FFA `[}
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPEOTOSIO NATURE DATE
DWELLING TO THE y-�PUBLIC SEWER
SIGNED THIS T—DAY OF P I NEW HOUSE SEWER f
OWNEROR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR K WORK
ADDRESS SEPTAND IO TAN
OR DRAINFIELD�(�
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL F) DRYWELL❑
CATIONAND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAdE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DI800NNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS AkQCLES COUNTY
AND STATE OF CA ORNIA OR THAT I AM THE LEGAL OWN- ABANDON HOUSE SEWER
ER OF THE ABO ESORIBE RES[ E IAL HOPE 8 0 ANK ❑
SIONATURE SEEP.PIT(S)[:] CESSPOOLS !' "zi
OF PERMITTE
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