HomeMy Public PortalAbout9557 GARIBALDI AVE_Sewer__ CEA
76A642D42D62 APPLICATION FOR PERMIT R__�7
COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
JOHN A. LAMBIE, County Engineer ADDRESS
WILLIAM A. JENSEN, Sup't of Building
LOCALITY
NEAR EST
FOR APPLICANT TO FILL IN CROSS ST.
LEGALJ -
DESCRIPTION LOT NO y OWNER
MAIL.
BLOCK - TRACT ADDRESS
NO. OF 5L GS.
SIZE OF LOT NOW ON LOT CITY TEL. NO.
USE OF
BUILDINGS DISTRICT NO. GROUP MAP PROCESSED BY
BK PG
CONTRACTOR iP!bg* Coo
..
ADDRESSCONNECTION DATA
7821 E - Garvey Ave. STATION DEPTH
CI TEL. NO. r
STATE UPPER
MANHOLE REFERENCE»>..,.
REGISTRATION NO. 134935C36 COUNTY "'�^'•�:. LOWER
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION ;LENGj,F,(FROM (t].
HOUSE SEWER CONNECTING TO Y. CURB P.L. M.L.TO P`.0"'"'�^ »-...,.,. v
PUBLIC SEWER @ $5.00 P.C.NO. V
SEPTIC TANK,SEEPAGE PIT OR $10 00 CO.IMP. NO. JOB NO. J
PITS AND/OR DRAINFIELD
HOUSE SEWER CONNECTING TO {�
TR,WNK PERMIT y0. P IT NO.
PRIVATE DISPOSAL SYSTEM @ $3.00 A' _ ,> -•',.,i �f. L.' ,,,:_ }
CONNECT ADDITIONAL BLDG.OR AF (DAVIT° WAIVER EASEMENT` RECORD. INSTR.NO. DATE �«
WORK TO HOUSE SEWER @ $3.00 Q
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL,DRYWELL.MANHOLE @ $5.00 HWY. OR ST.WIDENING O
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $3.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL
,.-E:HARG ES
OWNERS PERMIT $ z Oo
AUTHORIZATION I TOTAL FEE I
5 �k}1 CONNECTION CHARGE FEE
I HAVE AT THIS.DATE A CONTRACT WITH THE HEREIN NAMED CON- REIMBURSEMENT FEE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. APPROVALS DATE 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)
.1 HEREBY ACKNOWLEDGE THAT 1 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 CERTIFY THAT I AM PROPERLY REGISTERED AND/OR ALTER,REPAIR,SEWER OR
LICENSED AS REQUIRED BY LOS ANGLES COUNTY AND STATE OF SEWAGE DISPOSAL SYSTEM
CALIFORNIA OR THAT 1 AM THE Lzf
R OFAND INTEND ToDISCONNECT PLUG AND
RESIDE IN, THE ABOVE DESCRIBIAL PROPERTY ABANDON HOUSE SEWER
SIGNATURE
V BACKFILL SEPTIC TANKS 1:1OF PERMITTEE t ❑( ❑
SEEP,PIT(S) CESSPOOLS
VALIDATION ROBERT A. WOOD
CK. M.O. GASH
SUPERVISING MECHANICAL ENGINEER
,
DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL
DIVISION OF BUILDING AND SAFETY PERMIT AP ICATION
COUNTY OF LOS ANGELES :, ->
WILLIAM J. FOX, COUNTY ENGINEER I BUILDING
CASSATT D. GRIFFIN, SUaT of BUILDING ADDRESS
FOR APPLI ANT T FILL LOCALITY
BUILDING .` NEAREST
ADDRESS C CROSS ST.
LOCALITY DISTRICT NO.L SERIAL NO. PERMIT NO. C
NEAREST �� A � S
CROSS ST. RECEIVED BY Ready for Inspection DATE ISSUED
OWNER - 4L., / , . ,
MAIL USE ZONEOCCUPANCY MAP
ADDRESS I I SK PG
CITY TELAO.
CONTRACTOR CHARGES REIMBURSEMENT FEE
REQUIRED
ADDRESS
y NOT REQUI
CITY�.)<< ,i�- TF�i.IM.' �- f SOB CONNECTION CHARGE FEE
REGISTRATION NO. 7 COUNTY CO.IMP. NO. �- I
LEGAL RECEIPT NO. DATE I BY
DESCRIPTION LOT NO.
BLOCK TRACT WAIVER FOR RECORDING
SIZE OF LOTYjj— r N0.OF BLDGS. / RECEIPT NQ. I DATE BY
e NOW ON LOT
USE OF J°{��J.,�/}� T t,j �
BUILDINGS J� _1aclil.L�!_ TRUNK PERMIT N0.
NO. L DESCRIPT60N OF WORK
HOUSE SEWER CONNECTING TO ROAD PERMIT NO.
PUBLICSEWER 4@ $ 3.50
HOUSE SEWER CONNECTING TO STATE ENCROACHMENT
PRIVATE DISPOSAL SYSTEM 1.00 PERMIT NO.
CONNECT ADDITIONAL BLDG.OR INDUSTRIAL
WORK TO HOUSE SEWER 1.00 WASTE APPROVAL
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 STATION / � DEPTH
SEPTIC TANK,SEEPAGE PIT OR ! '
_ PITS AND/ORDRAINFIELD 2.00 MANHOLE REFERENCE -IF . j_"
CESSPOOL—DRYWELL _UPPER 5 LOW" -- � -
SPECIAL CONDITIONS ONLY 2.00 I TYPE OF CONNECTION LENGTH FROM D
Y.- CURB f3-,4— M.L.TO P.L.
OWNERSI PERMIT $ I 1 00
AUTHORIZATION TOTAL FEE
CONAED NTRACTOR TO CONNECT THTE
ABOVE D ED SCRIBEDWITH THEIEXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
J NEW HOUSE SEWER
SIGNED THIS..- ___..____DAY OF-- ... . ....................19
NECT
OWNER OR / �_' �r BUILDING NG OR WORKAL
OWNERS AGENT_Se(' �F{XA:[........` f LG/-�-•--
SEPTIC TANK,SEEP.PIT(S)
ADDRESS 2 .__;.... ..---- ...._.... ._-.._..__.. AND/ORDRAINFIELD
I HEREBY A KNOWLEDGE THAT I HAVE READ THIS APPLI- CESSPOOL❑ DRYWELL I]
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR SEWER
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 CA QQRNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOV�DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SEEP.PIT(S)E] CESSPOOLS 0
SIGNATURE t t
OFPERMITTEE '------------------- -------------......................-.......
.6A642D 663 12/.2