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Home My Public Portal About9241 GARIBALDI AVE_Sewer__r 76A64 D62 APPLICATION OR PERMIT �,,Z, 76A642D COUNTY OF LOS ANGELES SEWER—S WAGE DI POSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLU M A. JENSEN. Sup't of Building LOCALITY NEAREST FO PPLI AN FIL CROSS BT. LEGAL D R TION L(rr N OWNER /y� MAIL L31x / TRAC'T�- ADDRESS NO. OF BLDG$, SIZE OF LOT NOW ON LOj CITY TEL. NO. USE OF + DISTRICT NO. GROMAP PROCESSED BY BUILDINGGROUP MAP BK PG CONTRALTO K�e �.. ADDRESS C TION ATA ATION DEPTH CIT �� TEL. STATE UPPER �� CMANHOLE REFERENCE REGISTRATION NO. . -C/)rZJ� COUNTY C NO. DESCRIPTION OF WORK FEE TYPE OF CON CT LENGTH FROM HOUSE SEWER CONNECTING TO Y. P.L. M.L.TO P.L. PUBLIC SEWER @ $5.00 P.C.NO. SEPTIC TANK,SEEPAGE PIT OR $10.00 CO. IMP.NO. r ° JOB NO. V PITS AND/OR DRAINFIELD /j HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. 7 O _PRIVATE DISPOSAL SYSTEM @ $3.00 CONNECT ADDITIONAL BLDG.OR AFFIDAVIT WAIVER EASEMENT RECORD.INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD E W XTN.,CESSPOOL.DRYWELL,MANHOLE 0 $5.00 HY.OR ST.WIDENING N ALTER,REPAIR OR ABANDON HOUSE Z SEWE R DISPOSAL SY EM @ $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER'S PERMIT a i CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. I TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING TO THE PUBLIC SEWER. APPROVALS ATE INSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_ ' CONNECT ADDITIONAL ADDRESS BUILDING OR WORK SEPTIC TANK.SEEP,PIT(S) I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ I HEREBY CE IFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS E D BY LOS ANGLESCOUNTY AhD STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA H I AM THE LEGAL OWNER OF, D INTEND TO DISCONNECT PLUG AND RESIDE IN E VE DESCRIBE IDENTI L PERT ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ElOF PER MTTTEE SEEP,PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD CK. M.o. cnsH SUPERVISING MECHANICAL ENGINEER uj�o54991-0 OCT 15 1 1 0 25.00' 4 2 0 76A6 , APPLICATION FOR PERMIT 4?:4 76A6 COUNTY OF LOS ANGELES SEWER-SEW E d POSAL DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING JOHN A. LAMBIE, County Engineer ADDRESS WILLIAM A. JENSEN, Sup't of Building LOCALITY NEAREST I FO WSW O FILL IN CRD55 ST. LEGAL aw DESCRIPTION LOT 14.1 CA OWNER - BLOCK K/ AIL DRESS NO. OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE OF BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY BK PG CONTRACTOR zu ADDRESS " !✓ CONNECTION ATA �frV_ CITY TEL. ST TION DEPTH ❑ COUNTY OMANHOLE REFERENCE REGISTRATION NO. N . DESCRIPTION OF WORK FEETYPE OF CO E N LENGTH FROM } HOUSE SEWER CONNECTING TO Y. k- p,L. M.L.TO P.L. (L PUBLIC SEWER @ $5.00 P.C.NO. O SEPTIC TANK.SEEPAGE PIT OR CO.I.P. NO. JOB NO. PITS AND/OR DRAINFIELD @ $10.00 /^�� /17 HOUSE SEWER CONNECTING TO TRUNK PERMIT NO. ROAD PERMIT NO. Y X O PRIVATE DISPOSAL SYSTEM @ $3.00 [/ / CONNECT ADDITIONAL BLDG.OR AFFIDAVIT I WAIVER EASEMENT RECORD. INSTR.NO. DATE WORK TO HOUSE SEWER @ $3.00 OVERFLOW SEEPAGE PIT.DRAINFIELD EXTN..CESSPOOL.DRYWELL.MANHOLE @ $5.00 EPAIR OR ABANDON HOUSE HWY.OR ST.WIDENING H it ALTER,RZ SEWER OR DISPOSAL SYSTEM $3.00 STATE ENCROACHMENT PERMIT NO. INDUSTRIAL WASTE APPROVAL OWNER"S PERMIT s z 00 CHARGES AUTHORIZATION TOTAL FEE CONNECTION CHARGE FEE IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CONPm-1 -111-14rrEE - TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING 70 THE PUBLIC SEWER. APPROVALS TE 1IgSPECTOR'S SIGNATURE SIGNED THIS DAY OF 19_ OWNER OR NEW HOUSE SEWER OWNERS AGENT_�T_�� CONNECT ADDITIONAL BUILDIN ADDRESS G OR WORK SEPTIC 1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/O TANK,SEEP,PIT(S) AND/OR DRAINFIELD AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. CESSPOOL ❑ DRYWELL ❑ 1HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR LICENSED AS REQUIR LOS ANGLES COUNTY AN STATE OF SEWAGE DISPOSAL SYSTEM CALIFORNIA OR THAT THE LEGAL OWNER OF, AN INTEND TO DISCONNECT PLUG AND RESIDE IN, THE AB ESCRIBED RaIAL PR ERTY. ABANDON HOUSE SEWER SIGNATURE BACKFILL SEPTIC TANKS ❑ OF PER MTTTEE SEEP.PIT(S) ❑ CESSPOOLS ❑ VALIDATION ROBERT A. WOOD K. M.O. CASH SUPERVISING MECHANICAL ENGINEER C Uj;0 5 4 9 8%-10� GGA 15 1 () D 7.0 0- v •9 M-6D 11-54 APPLICATION FOR PERMIT -� a 4°DMSION OF BUMDING AND SAFETY SEWER—SEWAGE D I S SAL D pm�+,b,.r,�ew�,,, of Conatp Engles "r co=tI of I.OfI a;IIQt1,Ni A ..E . WM.J. FOX, COUNTY ENOINKKR ADDRESS CASIZATT D.GRIMN, SUPT OR ISUILDING IACALITT FOR APPLICANT TO FILL IN NEAREST CR033 ST. LEGAL � D LEGALTion LOT R0. OWNER BLOCK TSUMAIL ADDRESS NO. OF BLDGS. �J SIZE OF LOT O7'0 NOW ON LOT CITY T[L. NO. =1- '7 T USE OF BUILDING. �- DISTRICT NO. I GROUP I YAP CONTRACTOR BK PG ADDRESS �� CONNECTION DATA C1TT TEL. NO. STATION S DEPTH tr'VATE TZ/ ! YA EFEAQNC[ REGISTRATION NO. ❑ COUNTY sJ T PpER yam. TYPE NECTIO LENGTH FROM No, DESCRIPTION OF WORK FEE Y. Y.L.TO P.L. HOUSE SEWER CONNECTING TO .PUBLIC SEWER 3.30 HOUSE SEWER CONNECTING TO P IVATE DISPOSAL SYSTEM 1.00 +� ONNECT ADDITIONAL BLDG. OR WORK TO HOUSE SEWER 1.00 CO, EYP.H0J L7 —4- JOB. N0. ALTER OR REPAIR EXISTING [7 SEINER OR DISPOSAL SYSTEM 1.00 TRUNK PERMIT NO. ROAD PERMIT N0, . DISCpMNECT AND ABANDON SEER STATE ENCROACHMENT AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO. SEPTIC TANK, SEEPAGE PIT OR PITS AND/OR DRAINFIELD 2.00 INDUSTRIAL CESSPOOL- DRYWELL WASTE APPROVAL SPECIAL CONDITIONS ONLY 2.00 CHARGES CONNECTION CHARGE FEE OWIQE$'S PEBbUT s 1 00 AUTHORIZATION TOTAL FEE REIMBURSEMENT FEf TRACTOR1 HAVE THIS DATE TO CONNECT TIHEAABOVEACTED ~ITH THE DE3CRIBED EXIISTINGAMED CON- DWELLING AMOVAIS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEW P SIGNED THI DAY OF 19� NEW HOUSE SEWER OW�i ER OR CONNECT ADDITIONAL OWMQRS AGENT BUILDING OR WORK ADDRESS SEPTIC TANK, BEEP,?'IT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE HAT 1 HAVE READ THIS FPUCATION CESSPOOL[-IDRYlf[LL[IAND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY WITH ALL COUNTY ORDINAnCES AND STATE LAWS REGULATING ALTER, R PAIR .EY EB OR PLUMBING AND SEWERS. SELVAGE�IfPOt�AL SYSTEM ' I HEREBY CERTIFY THAT 1 AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STAT[ OF CALIFORNIA OR THAT. 1 AN THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER DESCRIBED RESIDENTIAL PROPERTY. RAC17ILL SOMC TANKS❑ SIGNATUR ___ ///►►► BEEF PFT(S) CItpP00 E OF FERMITTES3 W1LLu iw J. IrOX. CouNTr ENGIIIIRIR VALMILEON �3 0 2,7r a�t26 4 550 in by DEPUTY DEP RY Illy m DEPUTY DFNM _ i