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HomeMy Public PortalAbout9429 GARIBALDI AVE_Sewer__��9i40 2II-B3 APPLICATION FOR PERMIT 1 DriMON OF BUIIaDING ARID SAFETY . S EW E R----SEWAG E DISPOSAL D.pgft-.me of C-amsT Enginw Ott of La. ASM ABUIL .DDI1 . , JOHN A. LAMBIE,COUNTY ENOINISER DDREH3IIG m OAB81lTT D. OIRIF'FLN, 8UF'T OF BUYLDINa LOCALITY 17e FOR APDLICANT TQ FU IN CRO35IT'. D LECRIPTION LOT NAV 66-6- Cr S. /(6 OWNERMAIL ' BLOCK TRACT / AD.Rm' J NO.OF BLDGS,, /�� c SIZE.OF LOT ���� NOW ON LOI CITY TE L. MO. CJ. ��'17 USE OF BUILDINGS DISTRICT NO. ORO-0P YAP PG " CONTRACTOR 46 ADDRESS . Q CONNECTION DATA CITY TEL NO,Rllf 16 STATION 1 S DEPTH MAIIHOLE REFERENCE 4-8')ATE REGISTRATION NO. A4 Q' COUNTY MO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO T}'PE OF CONNECTIO LENGTH FROM Y. CURB P.L_ Y.L. TO .L. PUB IC SEWER Q #3.50 SEPTIC TAMir,SEEPAGE PIT OF- PITS AND/OR DRAINFIELD 3.00 OVEILFL011 SE PAG PIT.DRAINFI LD P, C. No. EM., F SPOOL,DRYWELL,MANHOLE 10 2.00 CO. IVP.N0. AMicRr HOUSE SEWER CONNECTLNO TO PRjVATE DISPOSAL 8Y M 0 S 7.00 TRUNK PERMIT 11ROAD PERMIT NO. CONNE ADDITIONAL BLDG.OR STATE ENCROACHMENT WORK TO HOUSE SEVER - Q "$1.00 PER-MIT N0. ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL ' SEVER OR DISPOSAL SYSTEM -1.00 WASTE APPROVAL CHARGES 'CON PMCTI 0N CHARGE FEE - Owwws PmbaT $ t 0 AUTHQETLA'Y'ION TOTAL FEF kEfYBU�%RSEMENT E I HAVE AT THIS DATP��RR $ A CONTRACT WITH T-HE HEEI11 NAMED COX- +-+ Mav DATE INSPECTOR'SStGHATURE TRACTOR TO CONNECT THE ABOVE DESCRIBED r;XISTING 7WELLING ' TO THE PUBLIC SEVER. NEW HQUSE SEWER i SIGNED THl AY OF 19 CONNE ADDITIONAL OWNER OR _ BUILD G OR.WOR[ .QWNE S AGENT ��'�� SEPTLCTANK,SEEP,PIT(S) ADDR AND/OR DRAINFIELD I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION CESSPOOLQ' DRYVELLE] AND STATE THAT THE ABOVE 15 CORRECT AXP AGREE TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS REG-Ul-ATIXG ALTER,REPAIR,SEWER Qty PLUMBING AND SEWERS, SEMAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AN PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND LICENSED AS REQUIRED BY LQS ANGELES COUNTY AND STATE OF DISCONNECT HO PLUGUSE AND CALIFORNIA OR THAT I AX HE, LEGAL OWNER OF, THE ABOVE 1WER 9CA UR RESIDE TI P SEEP.PIT(3EP71CCEISPOQ' O SIGNATURE Q' QF PERMITTEE JOHN A. LAMIRIE, COUNTY EN�INEER VALIDATION ROBERT A.WOOD, CHI"PLBO, INQPIECTOR Cc- X.0. CA" ' ACO 891'4,,q AUG 3 4 450 In