HomeMy Public PortalAbout9167 GARIBALDI AVE_Sewer__ DEPAJr*""N' OF OOUNTY ENCI NEMB SEWER—SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF IAS ANCU LM
WILLIAM J. FOX, COUNTY ENOINEIR BUUp� / 6
co r/
FWrr
TO RLL IN ,7111
BUILDINGS/ LOOALITY �?1� f FCS/
ADDRE90 /dT�+l/ ' 08088 8T. L E1 coo / Aug
LOCALITY / ` �� 018THIOT N0. SERIAL NO. PEMIT NO. .
NEAREST ST v-A-/ � 5 A 22 18 3�3 S
Ti RECEIVED BY Raab iK I�tIM DATE/ISSUED
OWNER 77/ � 3C�/ 2` 21D-53
ADDRESS AIL 1 v ��Q US[ZONfi OOOIJPANOY YAP
BK PQ
OITY - TELN O b Res.
CONTRACTO[ O/epD/L 00.IMP_NO. -2 - 5A
ADDRESS3 �a 0 T / LL J06 N0.
CITY 1hecn�4L- TELN405 J TRUNK PERMIT NG. �—
/ STATE
REGISTRATION R0.�pJ( L OOUNNTY ROAD PERMIT NO.LEGAL 0-� 2
DESOR1PT10N OT110." �I Q p O� y c� STATE HNOROACHMENT
PERMIT NO.
BLOCK TRACT INDUSTRIAL
NO.OF BLDGd WASTE APPROVAL
SIZfi OF LOT t7 ¢ NOW ON CHARGES
USE OF
BUILDINGS ' CONNECTION OHARGE FEE
NP DEBC�ZIPTION OF WAR FE[
HO asr-9E R 00 N N ECTI MG TO REIMBURSEMENT FEE
PUBLIO-SEWER - 0 1 " RECEIPT NO. DATE BY
HOUSl-SEWIER 00 M N ECTI III G TO
PRIVATE DISPOSAL SYSTEM 1.00
N EOT AbbITIONAL BLbe.Olk EXCEPTION BfiOORDED
WORK TO HOUSE SEWER 1-00
Ifff-O R REPAR Exi G NO- DATE BY
SEWER OR DISPOSAL SYSTEM ISO
DISCONNECT AND ABANDON ER
ANDOR DISPOSAL SYSTEM 1.09 CONNECTION DATA
&EPTIO TA EPAGE PIT ON
PITS AND/OR DRAINFIELD 2-M STATION DEPTH
(IESSPOOL-DRYWELL
SPEOIAL CONDITIONS ONLY 2.00 MANHOLE GEFE E
UPfE1r- T LOWER
TYPE OF CONNECTION LE GTH FROM r/
OWNERS PERMIT i I 00 Y. — CURB � P.L M.L TO P.L Z J
AUTHORIZATION TOTAL FES
I HAVE THIS DATE OONTRAOTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESORI ED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE P U0 dEWER
ER HOUSE SEW O 1412 2'1�"
OWNER OROONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIO TANK SEEP.PIT(S)
AND/OR DRAINFIELD
I HEREBY A6&OWLEDGZTHAT I HAVE READ THIS APPLI- CESSPOOLDBYWELL
CATION AND STATE THAT THE ABOVE IS OORREOT AND AGREE
TO COMPLY WITH ALL OOUNTY ORD111ANCES AND STATE LAWS ALTER REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAdE DIGPOl;AL SYSTEM
I HEREBY FY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AMD/OR U N8 AS REQUIRED BY LOS ANGELES COUNTY
AND STA OF LIFORNIA OR THAT I AM THE LEGAL OWN. ABANDON HOUSE SEWER
ER
OF TH ABO H D BED BE81 NTIAL PROPERTY. L P AN []
SIGNATURE BEEP.PIT(S)� OESSPOOLS,
OF PERMI
TEA"ID OU 1/53