HomeMy Public PortalAbout9567 GARIBALDI AVE_Sewer__ SdAeun -89 APPLICATION FOR PERM[
*4a�D11 ISION OF BUIMING.AND SAFETY SEWER--SEWAGE DISPOSAL
Dep-t-W of Cosat7 gnghmft
County at yo. Anv.Us B U I LD Ir(G
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JOHN A. LAMBIE. CduO � ARKSb
NTY ENINe
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m CAUSATT D.GRHFFIN, SUPT OF BUIL-DING LOCALITY
FO$ APPLI TO FILL IN NEAREST
C
LEGALEA
DESCRIPTION LOT AAt�L{.
BLOCK TAA CT AODAFaE
110.OF B4.DGS. CITY TEL Mar.
OF LOT OW ON T
USE DDIYfRICT NO. GROUP ■AP
BK PG
BUILDINGS Q ��
CONTRACTOR '
ADDRE! CONNEC,'TION`DATA
CITY�r TEL nqe� STATION DEPTH '
MANHOLE RAFERENCa UPPER
�q STATE
AkGIST'RATiON N0. d,�"!�' ❑ COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TSE OF ON LENGTH FROM
Y. C P.L.
M.L_T6 P.L.
PUB IC SEWER S,SO
SEPTIC TAN 'SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q f P.00
OVERFLOW 8"PAGE PIT,DRAINFIELD CO. I■p, X0. PN �
EXTN.,CESSPOOL, ELL MANH LE 2.00 OB0
HOUSE SEWER CONNECTING TO
PRIVATE DI Sp SAL SY M (a. 1.00 TRUNK PERMIT RO PERMIT NO.
CONNE ADDITIONAL BL '.OR STATE ENCROACHMENT
WORK TO HOUSE SEER $1.00 PERMIT NO. -
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEER OR PISPIOSAL SYSTEM Id f.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE -
OWNER'S PEUT $ 1 00
REIYBIIRSEYElIT FEE
A7MORIZATION TOT$I. FEET APPROVALS
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1 �AA
VE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- PPROVALS DATE INSPEGTOR'SSIGNATURE
TRACTOA TO CONNECT THE ABOVE DESCR EP EXISTING DWELLING D
TO THE PUBL_iC'SEWER, HEW HOUSE SEWER
SIGNED 7HIq DAY,0F_/ 19 CONNECT ADDITIONAL
OWNER OR y lt� J
BUILDING OR WORK
OWNERS AGE SEPTICTA11K,SEEP,PrT(S)
ADDRES A D/OR DRAI NFi LD
1 HEREBY CKNbWL GE THAT I HAVE READ THIS APPLICATION CESSPOOL❑ DRYWBLL❑
AN Q STATE THAT-THE ABOVE IS CORRECTAND AGREE TO COMPLY
fY1TH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTF,R,REPAIR,SEWER OR
PLUMBING AND SEWERS. SELVAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT i AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCON CTPLUGHOUSE lAND
CAUIFORNIA OR THAT Y THE GA WNER OF THE ABOVE
WER
DESCRIBED RESIDENTI P PERTY BACKFILL SEPTIC TANKS❑
tZ
SIGNATURE BEEP PIT(8)
OF PERMITTEE .
JOHN A. LAmaI ,COUNTY ENGINEER VALIDATION ROBER A.WOdD,LHIEF PLI3Q. INSPECTOR
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X.0. CAIH
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