HomeMy Public PortalAbout9559 GARIBALDI AVE_Sewer__ 24"6 DMIS
`"°' APPLICATION AOR PERM _[r'
7"644D
COUNT OF Los ANMD SEWER—SWAGE DISPOSAL
DEPAETUMM Of COUNTT MiGENM -
BUILDING AND SAF�Y DIVISION - ADORE"
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DESCRI PTS 011 110. r
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SIZE OF N 0 LOT CTEL NO.
NSE OF DISTRICT . GROUP` N" IIT
UILbIN
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CONTRACTOR
MDREW I� QNNBG*IION ATA
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STATE IANBOLS Rg�RKNCX PP
REa1JTnAnok No. couNTT
No,1 . OntRIPTIoNOFWORF
PUBLICSS COXX CTJXQTO 00
BEF71C TANK,SEEPAGE PIT OR T. TTP -0P COBE ON
TOP. ,.LLo( FL0
PITS AM DRAIXFIELD _
OYERFL01►SE]B'AGE.PIT DRAINFIELp
0 8 3EfER CONNECTI G TO P.
CC 1I��E /�DPO co-IMr.NO. JOB 0.
,WN
WN TO&DDJT9ElWLDG.OR `('BUNK PERMIT NO. ROAD PWRIT 010. -
PAIR OR ABANDON OUSE 100 STATE ENCROACHRHNTSPQS m
INL
PERMIT NO.
V ADUSTRf%V
AL c GEs
�rOWNEH'S PERM' 2 00 cONNEcnom CHARGEEE
F
AUTHO=ATION I TQM FEE REIYBUREE■ENT EE
I HAVt AT TRIO DATE A CONTR}4Ct RaTH THE MEIN 11AMED CbN-
TRACTOR TO CO"ECF TlJI{ ABO<•E DESCRIBED �YIOTIXO D11ELLIPIG AMOV DATA I"PECTOR-P RIGRATURR
TO THE PUBLIC SEWEIL
SIGN8{I THI$ .. +SAY OF IBS_ NEW HOUSE sE-1JH11
Qp7�1��$$R OR C NECT ADDIT14"L
b+YnN AGENT BUILDPNG OR WOFUC
ADDRMM EPTIC T#!�-[„SSA�F PIT(J)
M OR DRAINf1ELb
I-HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION -AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COYPL CESSPOOL DRTNEL
nTF( L COU ORDIXMC$6 Mp STATE LAWS REgULATI!(� AL REPAIR,JEfEROR
PLt1iBING MD SEN GH D19POSAL STSTB■
1 HffIHBT CERTIFY THAT Y A■ PROPURLT REGISrEREb ANWDR DISCONXfiCT P{UG AND
LICENSED AS REQUIRE]) BT LOS ANGELES COttJJtlTT AND ATE OF ABAtIDO HOUSE SEV�Ft - -
CALIFORNIA OR A7 Ta LE Olff OF VY
DESCRIBED RENIO PBACKFILL 81 C TANKS
51GNAT-u SEEP.PmB) CE33POOLS
OF PER I
m* VA7,II}} ZUF`XRVLeIQG hcmmcA. WOOD
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aABAXD
� Ae�ED APPLICATION FOR PERMIT
COMM OF LOS ANGELES SEWrER—SEWAGe DISPOSAL
DEPARTMENT OF COUNT? ENGINEER
BUILDING AND SAFETY DIVffiION B
UILDING � 9559 Garibaldi
OW A T[1l11TF /r /
"" " ``MW Temple (;i t
TYFOE APPLICANT TO IN /T
DESCRIPTION LOT NO.LEGAL 41 OWNER
MAIL
■LOCKADDRLOS
No. OF BLOOD.
BIZ[ OF LOT NOW ON LOT CITY TEL NO.
USOF I
BU[LDINGB DISTRICT �fd
MAP P oc BY
.11M
tONTRA�OR k4ose h Ca i l l i P 1 b . Co. S%a NO
J
ADDRESS 7821 E . GarveyAve, CONNECTIox DATA
CI"(7,San Gabriel TLS NO. T-05349 STATION DEPTH
R[OIDTRA,TION NO, 134935C36 C(?UT`.TY MANHOLE RE LOWER
No. DESCRIP'T'ION 6F, WORK Fill TYPE(OF CONNECTION M
OUSEBEyd[R c6mmKcTTNd TO Y. CURD PA_ M.L To P.
PUBLIC/EWER 0 je.0o P.C_No. /
BLPTIC TANK,SXIfPAQE PIT OR CO.IMP.NO JOB NO.
PITD AND/OR DRAINFI[L17 0 510.00
HOUSE SEWER CONNECTING TO
P NO.
PRIVATE DISPOSAL SYSTEM 0 73.00
CONNECT ADDLTIONAL BLDG.OR KIDAVI ■ [LIAR RXCOFth. INV".NO. DATE
WORK TO HOUSE SEWER a 53.00 3.00
OVERFLOW BEEPAG[PIT.DRAIMFIEL
EXTN..CfJISPOOL,PRYWELL 4A NH OLE 45 $5.00
A�.T[R.R PAIR OR ABANDO O RWY.OR ST.WIDENING
SEWER OR DISPOSAL SYS`TrK 13.00 STATE ENCROACH-MKNT
RERMIT No
INDUSTRIAL
WAST[APPROVAL
OWNER'S PI;RMT $ 21 00 ARG"
AUTHORIZATION TOTAL FEFL_ -0---:r,---0---:r,--CHARD E
I HAVE AT THIS DAT[ A CR
CONTRACT WITH THE HEREIN NAMED CON- REI U NT FE[
TRACTOR TO COMM BCT THE ABOVE DIC/CRIMKII ILXIGINQ DW LLLI110
TO THE PUBLIC SEWER. OVAL R DAT[ INSPECTOR'S U
6IONATRK
SIGNED THIS-DAY pP Ifl_
OWNER OR NEW HOUSE fr%NM
OWNERS AGSNT CONNECT ADDITIONAL
ADDRESS BUILDING OR WORK
SEPTIC TANK.SEEP.FIT(S)
I HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION AND/OR DRAINFI[LD
AND STAT[ THAT TH[ ABOVE )S CORRECT AND AGREE TO COMPLY '
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING GS.SS POOL El DRYW[LL ❑
PLUMBING AND B[WERS.
HEREBY CERTIFY THAT I AM PROPERLY RKGJ/T[R[D AND/OR ALTER,REPAIR,SEWER OR
LICENS[P AS R[GUIRE ■Y LOS ANGLES COUNTY AND STATE OF SEWAGE DI■POiAL SYSTEM
CALIFORNIA OR TTiAT M TH[ LEGA OW AN INT[ O DISCONNECT FLYO AND
RISID[ IN, THE AB DE/CRIB[D I R ABANDON HOGS[SEWER
BIGNATUR[
OF ltA MLIIS MCKFILL SEPTIC TANKS ❑
D REP.rfT(/) ❑ CESSPOOLS
VALIDATION ROBERT A. WOOD
M.O. CADH HUPEAVI81N� MECHANICAL ENGINEER
GK.
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