HomeMy Public PortalAbout9253 GARIBALDI AVE_Sewer__ � T
:;�,Iao APPLICATION FOR PERMIT 1
DIYlSION OF BUILDING AND SAFETY SEWER-SEWAGE D I SPOSA L
Dep-b-nt of Co-ty &Qftow
Cc" of Los Aa"les BUILDING l
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
m CASSATT D.GRIFFIN, BUP'T OF BUILDING LOCALITY
F
OR APPLI TO FILL CR . •
K O
LOT}I • Ot1IfiA
AILTYA ADDRESS/V 0 R OR LOT bISTRI R0. GROUP ■Ap
B[ PG
CONTRACTOR
ADDRESS 3 COMU=ON DAT)L
STATIO DEPTH ov
CITY TEL 1110, D U ■AXHOLE REFER@It.E /1 UPPER
REGISTRATION No, ❑ STATE b
/3 O � COUNTY _
No. DESCRIPTION OF WORK FEE
OUSE SEWIER CONNECTING TOTYPE OF CONNECTION - LENGTH FROM
�ueu ,<E
c aHR 43.50 w
Y, CURB P.L. R.L.TO P.L
IC TAA[,SEEPAGE PIT OR 001
-
PITS ARD/OR DP-AINF18LD 0 :3.00
OVERFLOW SESPAOfipIT,DRAINFIELDCO, INP. X0. I77 JOBC.NO�
I E)[TX„CESSPOOL DRYWELL,YAXHOLE =2.00
i HOUSE SERER CONNECTING TO
i PRIVATE DISPOSAL SYSTEM 8 f 1.00 TRUNK PERMIT N0. ROAD PERMIT NO.
CONNECT ADDI IOk//��L BLDG.OR STATE ENCROACHMENT
WORN TO HOUSE aEIYER 8 1.00 PERMIT NO. - -
ALTER,R AIR OR ABANDON HOUSE
IXDusrRIAII,,
SEWER OR DISPOSAL SYSTE 1.00 NASTE AMOVAL -
CHARGES
CONNECTION CHARGE FEE
.OWNER'S PEST i t 00
AUTHORIZATION TOTAL FEE 4—
I
REIYDU�RfEYpSNT FEE,
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR•SSIGNATURE
TRACTOR' TO CONNECT THE ABOVE DE34RIBED EXISTING DWELLING
TO THE I`UBLIC S 2 `A NEW HOUSE 9EWER
SIGNED THI A F 1>�] CONNECT ADDITIONAL
OWNER OR BUILDING OR WOR[
OWNERS AGENT SEPTIC TAX[,SEEP,PIT(S)
ADDRESS AND/OR DRAIXFIELD -
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION- CESSPOOL❑ DRY1lE11.❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGUTATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTE-M
1 HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED B7 LOS AHGELEE COUNTY AND bTATE OF ,,+gAXDOR HOUSE SEWER
CALLFORNIA OR THAT I AY THE LEGAL OW ER OF T E ABOVE
DESCRIBED RESIDHlITIA P PERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINERR VALIDATION ROBERT A.WOOD, CHIEF PL EIG. INSPECTOR
Ci. Y.0. CAIS - - - -
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