HomeMy Public PortalAbout9227 GARIBALDI AVE_Sewer__ DEPARTM ENT OF OOUNW ENGINIEM AND SAFETY SEWER-SEWAGE DISPOSAL
1
bMSION OF BUILDING
OOUNTY OF LOS ANGFff PERMIT APPLICATION-
WILLIAM
J. FOX, COUNTY EN131N1[[R BUILDING
ADDRE88
FORA-P RU CANT T HLL IN LocALITY
BUILDING /�J - NEAREST /
ADDRE88 C-R 0as ST. \
LOCALITY I DISTRICT NO. A SERIAL NO. PERMIT NO. c
NEAREST .. A S
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CROSS ST.
OE ED Ready for ImispNtlo■ DATEISSUED
OWNERMAIL
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ADDRESS y,�._}.y USEZONE OCCUPANCY B—MytP�—
CITY 4 t �`��C� �Q �' •�
CONTRACTOR / CO.IMP.NO.
ADDRESS
J 0 B NO.
CITY E TRUNK PERMIT N0. —^
STATE
REGISTRATION N0. G COUNTY COAD PERMIT N0.
LEGAL
DESCRIPTION LOT NSTATE ENCROACHMENT
0. PERMIT NO.
BLOCK TRACTJ�7�� �N INDUSTRIAL �
1
'� y ■vim WASTE APPROVAL
SIZE OF LOT OF BLDGS.
NOWN0. ON LOT CHARGES
UBE OF
BUILDINGS CONNECTION CH E FEE
NO. DESCRIPTION OF WORK FEE REIYBURSEMENTFEE
OUSE SEWER CONNEOTINB TO
PUBLIC SEWER t $ 8.6o S BEOEIPT NO. DATE BY
HOUSIE SEVER tONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CO TIONAL BLDCEPTION CORDED
WORK TO HOUSE SEW1R 1.00
ek RIEPAIR I D• DA BY
SEWER OR DISPOSAL SYSTEM IA/
DISCONNECT AND ABANDON SEWER
AND OB DISPOSAL SYSTEM 1.90 CONNECTION DATA
SEPTIC TANK.SEEPAGE
PITS AMD OR DRAINFIELDPIT OR LOG STATION 07 71 DEPTH
L—D RYW 9 L L
SPECIAL OONDITIO"ONLY LSO MANHOLE REFERENCE
(J UPPER �—t6iMtR'
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT ; 1 CURB Pj., MT
TO S�
AUTHORIZATION TOTAL FEE L-
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
DONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS IN&PEOTOR`SSIGNATURE DATE
DWELLING TO THE PUBLIC SEWER -t
SIGNED THIS DAY OF Iq NEW HOUSE SEVER llr4
OWNER OR yBUMLDI B ORD
DWORKAL
OWNERS AGNECT ENT
SEPT10 TANK SEEP.PIT(S)
ADDRESS AND OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL[:] DRYWELL
CATIONAND STATE THAT THE ABOVE 18 CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND RTATE LAWS ALTER.REPAIR SEWER OR
REGULATING PLUMBING AND SEWERS- SEWAGE DISPOIIAL SYSTEM
I HEREBY CERTIFY THAT I AN PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICE IN
AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL N-
EB OF THE ABOV[ D BED REST IAL rROP BACKFILL TANKS[]
sEKr.PIT(S)E] OESSPOOLB
BIGNATURE _
OF PERMITTE
TUA42A 088 T/63 " rl L •`f�GyC ��c.(1�