HomeMy Public PortalAbout9240 GARIBALDI AVE_Sewer__ DEPARTMENT OF COUNTY FNGIIVEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
NG
WILLIAM J. FOX, COUNTY ENGADDRE
INEER
ADDRESS �-,7 � `---"' � •.' �;.� '
LOCALITY
F R APPLICANT;TO FILL-IN LOCt
BUILDING NEAREST *� ,
ADDRESS CROSS ST. /
DISTRICT NO. SERIAL NO. PERMIT NO.
LOCALITY S
NEAREST `l _
CROSS ST. RE EVIEC BY Ready for Inspection DATE ISSUED
OWNER
MAIL USE ZONE OCCUPANCY MAP
ADDRESS 4- BK PG
CITY07- TELNO.
CONTRACTOR CO.IMP.NO. 7 777 �?
ADDRESS 0- JOB.NO.
CITY TEL.NO.,47Z TRUNK PERMIT NO.
$ STATE ��
REGISTRATION NO. '❑ COUNTY ROAD PERMIT NO. � -7�L`;
LEGAL STATE ENCROACHMENT
DESCRIPTION LOT N0. PERMIT NO.
BLOCK TRACT INDUSTRIAL
WASTE APPROVAL
SIZE OF LOT t OF BLDGS. CHARGES
v ON LOT
USE OF / �'; CONNECTION CHARG EE
BUILDINGS _ _
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONN EiffM TO
PUBLICSEWER @ $ 3.50 i RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION kCORDED
WORK TO HOUSE SEWER 1.00 NO. DAT BY
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM I.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION DEPTH
CESSPOOL—DRYWELL la
I MANH REFERENCE
LOWER
SPECIAL CONDITIONS ONLY 2.00
TYPE OF U CTIOj,, LENGTH FROM 2
M.L.TO P.L.
OWNERS PERMIT $ 1 1 00
AUTHORIZATION TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
HAVE
TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER 19_1.
` i.1�* NEW HOUSE SEWER x'
SIGNED THIS...._.___.._..DAY OF L-------------==--......----
CONNECT ADDITIONAL
OWNER OR ,��p BUILDING OR WORK
..KERS AGENT .. aa+ar� ------....._............._...-
/» SEPTIC TANK,SEEP.PIT(S)
ADDRESS-1.,:_ . .il 1•:• =�'._:.-.._..::.... - AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL❑
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER.REPAIR,SEWER OR
REGULATING 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 ABOVELDRIBED RES ENTIAL PROPERTY.,, BACKFILL SEPTIC TANKS 7 /
SEEP.PIT(S)[] CESSPOOLS
SIGNATURE " pp
OF PERMITTE --'--r- -
76A642A 663 7/53