HomeMy Public PortalAbout9620 GARIBALDI AVE_Sewer__ DEPARTMENT OF COUNTY ENGINEER SEWER-SEWAGE DISPOSAL 1
DIVISION OF BUILDING AND SAFETY PERMIT APPLICATION
COUNTY OF LOS ANGELES
WILLIAM J. FOX, BUILDING CL:;.-Z^ /
COUNTY ENGINEER ADDRESS . 1 t7 2 G• �.7�' 4 K-'J 6A': l'
FOR APPLIC TO,�YLL IN LOCALITY
BUILDING NEAREST ,
ADDRESSts CROSS ST.
_ LOCALITY DISTRICT NO. SERIAL NO. PERMIT NO. c
NEARES �( A Y? 5
CROSS ST. \ - ' RECEIVED BY Ready for Inspection DATE ISSUED
OWNER
MAIL USE ZONE OCCUPANCY BK MAP PO
ADDRESS
CITY _19TEL.NO 1
"1 .6-1CONTRACT �kukol CO.IMP.NO.
ADDRESSL_jjEjM JOB.N0.
CITYy TEL.NO-_ $ 6� TRUNK PERMIT N0. -
A`� a STATE
REGISTRATION N0. �-, ROAD PERMIT N0.
LEGAL { — / STATE ENCROACHMENT
DESCRIPTION LOT NO.,o, y PERMIT N0.
BLOCK TRACT, (�J'`�I/ INDUSTRIAL
WASTE APPROVAL "
SIZE OF LOT), NOW ON LOTS CHARGES
USE OF
BUILDINGS CONNECTION C E FEE
NO. DESCRIPTION OF WORK FEE REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO
_PUBLICSEWER @ $ 3.50 RECEIPT NO. DATE BY
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEPTION RECORDED
_WORK TO HOUSE SEWER 1.00
ALTER OR REPAIR EXISTING NO I DATE I BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
_ AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR ' DEPTH
PITS AND/OR DRAINFIELD 2A0 STATION
&ESSPOOL—DRYWELL
_SPECIAL CONDITIONS ONLY 2.00 /��.=' J 'f C OMAN P ER EFERENCER
L TYPE OF CONNEQTIOy LENGTH FROM
OWNERS PERMIT ; I 00 Y CURB 211M.L. M.L.TO P.L. Z�
AUTHORIZATION I TOTAL FEE
I HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE//PULIC SEWER
SIGNED THISX_..�I4?-»_/_� Y OF.__ _Iq� NEW HOUSE SEWER
OWNER OR CONNECT ADDITIONAL
OWNERS AGE T-.._. BUILDING OR WORK
SEPTIC TANK.SEEP.PIT(S)
-ADDRESS. ..��. _ .:Ito_-_..-....-.- .- AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ 1WHIS AP I- CESSPOOL❑ DRYWELL❑
CATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE
TO COMPLY WITH ALL COUNTY ORDINANCES AND STATE LAWS ALTER,REPAIR,SEWER OR
REGULATING PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY EGIST ED DISCONNECT PLUG AND
AND/OR LICENSED AS REQUIRED BY LOS ANGE S C TY
AND STATE OF CALIF IA OR THAT 1 AM THE L GA 0 N- ABANDON HOUSE SEWER
ER OF THE VE S ISID AL P ER
RE BACKFILL SEPTIC TANKS
SEEP.PIT(S)[] CESSPOOLS
SIGNATU
OF PERMITT -- • - ---------••------ -
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