HomeMy Public PortalAbout9658 GARIBALDI AVE_Sewer__ D
S&E-689 11.85 APPLICATION FOR PERMIT 1
S&E.8
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL
Deportment of County Engineer
County of LOS Angeles BUILDING /°
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS (�
® CASSATT D. GRIFFIN, SUPT OF BUILDING LOCALITY
FOR APPLICANT TO FILL IN CROSS ST. w'
LEGAL "�`
DESCRIPTION LOT NO.�✓ �{s L� OWNER
MAIL
BLOCK TRACT / / ADDRESS
(i4 6
NO. OF BLDGS. CITYT EL. NO.
SIZE OF LOT NOW ON LOT
USE
ELDINGS OF DISTRIC] 0. GROUP MAP
BUIBK PG
CONTRACTOR _ k
ADDRESS CONNECTION DATA
CITY ( 7EL. NO. ` STATION ;� DEPTH
MANHOLE REFERENCE
�V 2- 7zf— STATE --� LOWER
REGISTRATION NO, l �^� COUNTY
NO. DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE OF CONNECTION LENGTH FROM
PUBLIC SEWER @ $3.50 Y. CURB P.L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD Q $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO.
i
EXTN.,CESSPOOL,DRYWELL,MANHOLE Q $2.00 CO. IMP. N0. 10B NO.
t HOUSE SEWER CONNECTING TO
i PRIVATE DISPOSAL SYSTEM Q $1.00 TRUNK PERMIT NO. ROAD PERMIT NO. /
i CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
i
WORK TO HOUSE SEWER Q $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM Q $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE I
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DES ED EXISTING DWELLING _ `l
TO THE PUBLIC SE E tt '' NEW HOUSE SEWER 'j- ;�.J'Ij .lr :'•�,.� '
SIGNED THIS D Y 19� CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AG SEPTIC TANK,SEEP,PIT(S)
ADDRESS ° AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 WAVr R AD THIS APPLICATION' CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS, SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BYLOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDEN I PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURESEEP.PITS) ElCESSPOOLS[3OF PERMITTEE
JOHN A. LAMBIE, COUNTY N NEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
Y.0. CASH
jto 2 4 1 6 SEP 18 4 450 �