HomeMy Public PortalAbout9616 GARIBALDI AVE_Sewer__ APPLICATION FOR PERMIT- 1
■�wee ttae -
DNISION OF BUIWING AND SAFETY SEWER---SEWAGE DISPOSAL
D.mft2.ns d Coane,' Expo r
CoumtY of Los es+ ADDM"
JOHN A.LAMBIE,COUNTY ENOINXIER
m CABSATT D. ORWFIN, HU"of BUILDING }.00ALITT -
FOR APPLICANT TO FlU IN CROW ST.
LEGAL OWNER
LOT NO. "
MAIL
BLOCK TRACT ADDRESII
RO 'OF SLUGS. CITT TEL. 110
SIZE OF L T 110 OR LOT
_F
BUILDINGS DUSEODISTRICT NO. GROUP LAP
UI '
B[ PG
CONTRACTOR
A
ADDREa9 CON!(EGTIbN DAT
STATION DElTH
'CITY Tgt,. no/ MM
MANHOLE RE ERENCE UPPER
LOWER
REGIS ON O, V 2/
NO. DESCRIPTION OF WORK FEE TYPE OF COXNECTIQM LENGTH FRbM
NOOSE smER CONNECTING TO Y. CURB P.L. Ill.L.TO P.L.
PUBL SEVER S 3.50
S PTIC•TAXK,SEEPAGE PR OR '
P SS AXD/OR DRAINFIELD 3.00
0 LOW SEEPAGEDRAINFIELD CO. IMP. N0. JOB MO..
ESTM_,Cul OOL D 71LL AN HOLE Q 2.00
NOOSE SEWER CONNECTING TO
PRIVATE DISPOSAL STMU ;t.00 TRUNK PERMIT N0. ROAD PERMIT NO.
CONNECT ADDITIO AL BLDG.OR STATE ENCROACHMENT
OR[TO HOUSE SEWER @ S t.60 PERMIT X0. , d d L
ALTER..REPAIR OR ABA DON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTE 4-00 WASTE APPROVAL
C H AR8 E5
CONNECTION CHARGE TEE'
OVPNMIS PmwT 1 00
A=OA=TION TOTAL FEE REIIIBURSEMEXT FEF
I HAVE AT THIS DATE A CORTRACT WITH THE ER1;14 NAMED CON- APPROVALS DATE INSPEC'iOR`9SI.GiNATURE-
TRACTOR TO CONNECT THE ABOVE DESCRIBED _EXISTIN-G DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SERER
SIGNED THIS nAY OF 19CONNECT ADDITIONAL
OWNER OR BUILDING OR WOifK
OWNERS AGENT SEPTIC TANK,SEEP,PIT(3)
ADDRESS AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE HEAD THIS APPLICATION CESSPOOL❑ DRY-WELL❑
AND $TATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY '
WITH ALL COUNTY ORDINANCES AND STATE I.AVJS REGULATI" ALTER,REPAIR,SERER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SY M
I HEREBY CERTLFY THAT I AN PROPERLY REGISTERED AND/OR AND
A
DISCONNECT PLUG
LICENSED AS REQUIRED $Y LOS ANGELES COUNTY ANP STATE OF ABANDON HO LUG
CALIFORNIA OR THAT 1 AY THE GAL OW OF B
SESEWER
DESCRIBED-fW,illll M A BACKFILL SEPTIC TANKS❑ T•i'� ;
BIGXATURFJ//LV Q� O, SEEP,PIT(S) ❑ CESSPbo t
OF PERU
JOHN A. LAMBIE, COUNTY PENOINEER VALIDATION ROBERT A.WOOD, CHIEF PLBO. INSPECTOR
u. X.o,
Lnjo2 7 2 4ZR MV26 4 2.0 .0 Q .