HomeMy Public PortalAbout9237 GARIBALDI AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL 1
COUNTY OF LOS ANGELES .�1`MIT APPLICATION
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
1 - CASSATT D. GRIFFIN, SUPT OF BUILDING
FOR APPN TO FILL IN LOCALITY
BUILDING 1 • NEAREST
ADDRESS CROSS ST. C/K
LOCALITY DISTRICT NO. SERIAL N0. PERMIT NO.
NEAREST //; A S
CROSS ST.
RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL
ADDRE S • USE ZONE OCCUPANCY MAP
BK PG
CITY" T5 L.NO.
CONTRACTOR CHARGES REIMBURSEMENT FEE
ADDRESS " All REQUIRED
NOT REQUIRED `
CITY • :TEL.NO
JOB.N0. -- CONNECTION CHARGE FEE
REGISTRATI N N0. STAFIEOO �w3l CO.IMP.NO.
LEGAL i CRECEIPT NO. I DATE I BY
DESCRIPTION LOT NO. �. GP
BLOCK 4 TRACT WAIVER FOR RECORDING
SIZE OF LOT • NO.OF BLD RECEIPT N0. I DATE BY
d O NOW ON LOT
USE OF
BUILDINGS .
NO. DESC IPTION OF WORK FEE TRUNK PERMIT N0.
HOUSE SEWER CONNECTING TO ROAD PERMIT N0.
PUBLIC SEWER @ $ 3.50
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSAL SYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 STATION DEPTH
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 MANHOLE REFERENCE
CESSPOOL—DRYWELL I� UPPER LOWER
SPECIAL CONDITIONS ONLY 2.00 TYPE OF CONNECTION LENGTH FROM
Y. CURB P.L. M.L.TO P.L.
OWNERS PERMIT $ I 00 -
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS....................DAY OF ...................19.... NEW HOUSE SEWER J
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT.-...--7� !._"C_jui.E.f._ ..___Q° ? ------ BUILDING OR WORK
SEPT'C TANK,SEEP.PIT(S)
ADDRESS-----------------------------------------------------------------........................... AND/ORDRAINFIELD
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS'APPLI- CESSPOOL El DRYWELL
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
RECULATiNG PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOUSE SEWER
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DE RIBED DENTIAL PROP TY. BACKFILL SEPTIC TANKS El
`.
SIGNATURE SEEP.PIT(S)o CESSPOOLS Q
OF PERMITTEE 4 . _..._ __ -- ... ._ 4---..
i6Ab4'lU fih3 12/5'2
78A8411t-57
CE808 APPLICATION FOR PERMIT 1
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING /
JOHN A. LAMBIE, County Eagmee� ADDRESS {pcSCr/ t
CASSATT D. GRIFFIN, Supt of Building LOCALITY
FOR APPLICANT TO FILL CROSS sr.
LEGAL
DESCRIPTION LOT NO. M / zr PL rlA !e
_rte OWNER �_Q QJ&-e- r
Al L
BLOCK TRACT ' L S �� /1I Ia 1 (I6l ADDRESS
NO.OF BLDGS. ...
SIZE OF LO NOW ON LOT CITY TEL.NO.
USE OF
BUILDING Aj DISTRICT NO. GROUP MAP
BK PG
CONTRACTOR
ADDRESS <7 CONNECTION DATA
CITY --- TEL.NO. -1 "Y STATION DEPTH
g� / ❑ PA
ST MANHOLE REF E UPPER
REGISTRATION NO. -1 Y 1 ❑ COUNTY LOWER
NO. DESCRIPTION OF WORK' FEE
HOUSE SEWER CONNECTING TO
PUBLIC SEWER Q $3.50 TYPE OF CONNECTION LENGTH FROM
SEPTIC TANK,SEEPAGE PIT OR Y. CURB - P.L. M.L.TO .L.
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.
PRIVATE PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP. NO. N0.
CONNECT ADDITIONAL BLDG.OR - ,
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. AD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROV
Z Ns
CHARGES
OWNERS PERMIT $ 1 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON.
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19_ NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGENT BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP, PIT(S)
AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICAT ON
STATE THAT THE ABOVE IS CORRECT AND AGREE TO CO LY CESSPOOL❑ DRYWELL❑
ITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR.SEWER OR
LUMBING AND SEWERS. �/ ) SEWAGE DISPOSAL SYSTEM
HEREBY CERTIFY TOT 1 AM PROPERj.Y REGISTEREDR DISCONNECT PLUG AND
AS REQUIRED. BY LOS ANQQELE$' COUNTY AND S ATE F
LIFO OR THAT i AM THE LIEGAk OWNER OF Tt;.A601G( ABANDON HOUSE SEWER
ESCRI E RESIDENTIAL PROPERTY -,/� / BACKFILL SEPTIC TANKS ❑
N R 4m -.�/,. .,. %A t, SEEP. PITS) El CESSPOOLS ❑
M 4 iE
®� VALIDATION ROBERT A. WOOD
M CK. M.;O. SH SUPERVISING MECHANICAL ENGINEER
1_T03 9 2 1 a km 15 1 O A 2.00