HomeMy Public PortalAbout9427 GARIBALDI AVE_Sewer__ APPLICATION. FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEW E R-SEWAGE D I S POSA L
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WM.J. FOX.COUNTY ENUINmI SB
CUWATT D.GRIMM,SUP-fotr■Un-DYNS s
FOR APPLICANT TO FII.I1 IN
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LEGALf' ,. 10
DESCRIPTION ti� o"ER
,LOCI TRACT 5 PAIL ±r h
ADDREIS
No. OK BLDGS.
SIZE OF LOT X NOW ON LOT CITY TSL N0.
USE OF
B
U.
GS DISTRICT Rd. GROUP SK YAP PG
CONTRACTOR �- --
ADDRESS CONNEMMA DATA
CITY �,�lL M0,j� �l i STATION DEPTH
g MANHOLE REFERENCE
REGISTRATION No. I / ❑ COUNTY LOW EM
No. DESCRIPTION OF WORK FEE
TYPE OF CONNRCTI LENGTH FROM
HOUSE SEWER CONNECTING TO '� Y. CURB P.L. M.L.TO P.L.
PUBLIC SEWER 3.30
HOUSE SEVER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.ORP.t. N0.
WORK TO HOUSE SEWER 1.00 ��y
ALTER OR REPAIR E2SYSTEM
TRUNK PERMIT NO. ROAD PERMIT NO.
� SEWER OR DISPOSAL SY9TE■ 1.00
9DISCO!!((HECT AND ABANDON SEWER STATE ENCROACHMENT
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
I SEPTIC TANK,SEEPAGE PIT OR
PITS AHD/OR DRAINFIELD 2.00 INDUSTRIAL
CESSPOOL-DRYWELL WASTE APPROVAL
SPECIAL CONDITIONS ONLY 2.00 C
ebur CONNECTION CHARG[F[E
O�S$'S S 1 00
AUTSOBMATION CT�TOTAL FEE sj�l RGIIBO1tR7➢�E7fYpElIT FEE
TRACTOR TOI HAVE CONNECT TTDATE HEAABOVE WDESCR DESITH THE CRIBED EA IER ESTI 9A D1t lSLLIN4 +'MOYAIS �IDAATE IXNSPEC RC[SillG4ll/If�iUR[ G
TO THE PUBLIC SEWER
SIGNED THIS nAY OF 19- NEW HOUSE SEWER -
OWAER OR r! /' 1 1 i (� CONNECT ADDITIONAL
OWNERS AGENT_ BUILDING OR WORK
SEPTIC TANK,BEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOL[IDR"YWELL E)AND STATE THAT THE ABOVE 13 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCE" AND STATE LAWS REGULATING ALTER REPAIR,SEVER OR
PLUMBING AND SEWERS. SEWAdC DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATS OF DISCONNECT PLUG AND
CALIFORNIA OR•THAT I AM THJI LEGAL OWNER OF THE ABOYR ABjkNDON HOUSE SEWER
DESCRIBED RESIDKNTIAL PROP BACKFILLC TANkS❑
a SEEP IT(5)
TS CESSPOO-[,S
[1GNATUR[ �
OF PERU ITTEEJ(?l9:n"
WILLIAM J.FOX,CoumTY ENG LNtm VAL ii;;, R-A,WOOD. CHIcr PLIM. INQ[GTOR
LT,04082�R MAR13 4 450 �