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HomeMy Public PortalAbout9625 GARIBALDI AVE_Sewer__ r) 7 EA842D CAPPLI A ION F R PERMI E608 8-5e 7 COUNTY OF LOS ANGELES SEWER-SEWAGE DISPOSAL 1 DEPARTMENT OF COUNTY ENGINEER BUILDING AND SAFETY DIVISION BUILDING / 2=_ JOHN A. LAIE, County Engineer ADDRESS (p CASSATT D. GRIFFIN, Supt of Building LOCALITY . CZ NEAREST FOR APPLICANT TO FILL IN JCROSS STLEGAL . DESCRIPTION LOT NOO 3,•' 4 _OWNER ��•/'� �`%��© BLOCK TRACT ADDRESS y ��...7 NO.OF BLDGS. SIZE OF LOT NOW ON LOT CITY TEL. NO. USE 0 BUILDINGS K PG DISTRICT N0. GROUP MAP PROCESSED BY B CONTRACTOR © ^ t/ ADDRESS — V CONNECTI N DATA CITYTEL.NO. 7 ' 7 STATION 3 DEPTH STATE MANHOLE REFERENCE REGISTRATION NO. 2 9 ® COUNTY NO. DESCRIPTION OF WORK FEE HOUSE SEWER CONNECTING TO PUBLIC SEWER @ $3.00 0 TYPE OF CONNECTION LENGTH FROM SEPTIC TANK,SEEPAGE PIT OR Y. CURBP.L. M.L.TO P.L. PITSAND/OR DRAINFIELD @ $3.00 OVERFLOW SEEPAGE PIT,DRAINFIELD EXTN..CESSPOOL.DRYWELL @ $2.00 HOUSE SEWER CONNECTING TO P.C.NO. PRIVATE DISPOSAL SYSTEM @ $1.00 CO.IMP.NO. / 332, JOB NO. CONNECT ADDITIONAL BLDG,OR TRUNK PERMIT NO. ROAD PERMIT N0. WORK TO HOUSE SEWER @ $1.00 ALTER,REPAIR OR ABANDON HOUSE STATE ENCROACHMENT SEWER OR DISPOSAL SYSTEM @ $1.00 PERMIT NO. INDUSTRIAL WASTE APPROVAL CHARGES OWNERS PERMIT $ 2 00 CONNECTION CHARGE FEE AUTHORIZATION FOTAL FEE - REIMBURSEMENT FEE 1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE TO THE PUBLIC SEWER. SIGNED THIS DAY OF 19_ NEW HOUSE SEWER''! OWNER OR ,. CONNECT ADDITIONAL OWNERS AGENT 4/6� BUILDING OR WORK ADDRESS SEPTIC TANK,SEEP.PIT(S) AND/OR DRAINFIELD 1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL El DRYWELL [IWITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING PLUMBING AND SEWERS. ALTER,REPAIR,SEWER OR SEWAGE DISPOSAL SYSTEM 1 HEREBY CERTIFY THAT I AM PROPERLY EGISTERED AND/OR DISCONNECT PLUG AND LIC ED S REQUIRED S ANGELES UNTY ND STAT OF ABANDON DISCONNECT D C FORN OR THAT 1 AM THE LEGAL WNER 0 TX ¢'OVEHOUSE D RIB ESIDENTIAL ROPERTY. BACKFILL SEPTIC TANKSSVa SEEP.P]T(S) ❑ CESSPOOLS ❑ PERMIT OF, VALIDATION ROBERT WOOD CK, Y.0. CASH SUPERVISING MECHANICAL ENGINEER LtCo2035 JAl