HomeMy Public PortalAbout9659 GARIBALDI AVE_Sewer__ 7aAa,2o
CE&N"?E'.°"a' APPLICATION IFOR PERMIT _
01 SEWER - SEWAGE DISPOSAL
COUNTY OF LOS ANGELES BUILDING AND SAFETY
FOR APPLICJ►NT TO FILL INS wa aaour aLAr o BY s
.ULLorNO f r�.Err6`.alo J'3, 4
ADLMlDB
LOCALrrY �� �� C f. CONNEMON DATA
NSA 1TAT}ON DBT]-H
C"Oss ST.
YMIHOLE RIAIIING[ LOWER
TYPE DP N - -LiTiQTH FROM .3
ADD Ralf
CO.IMF.NO. - 3 2 JOB NO•. .
c rrY TEL No. 8 2 d
LEGALTRUNK PERMIT NO. ROADPERMrrN0 C3
oEICRE•TION LOT No.
APFIDAvrr I YAN[II Lkse-m Drr RECORD.INsTr1 NO, DATE
BLOC-K TRACT
NO.OP sLDGD.
Bctz OF LA7 NOW ON LOT HWM.OR 8T.W[DBNINO
USE OF
DINae DI
eu[ �..5. STATE BNRC
COAHYENT
FEnM rr No.
LNDUCONTAALTOR l'i�aa G SAL
A.. Q/. O . i 8 J CHARGED
crrY G /4 TEL NQ. CONNECTION CHARQE FEE
fTAT[ �/ !^! LJC. - RB ON e U RDs M E NT FE[
LSCS NSE No. Z j 6•�s .i c— 2
NO. DRStRIPTION OF WORK .FE[ APMVALS DATq INSPECTOR'S SIGNATURE
/ HOUR■SBW[R CONNECTIiG TO ry
PUBLK snvr" NEW HOUR[OKWER J
SQTIc TAN Ktl[EPAO[FTT OR .. - _. - ,
FlTBAND/O DRAINFIElb CONNECT ADDMONAL,
HOUSE SEWER CONNECTING TO BU[DING ORWOfW
PRIVATE D ISPOSAL-BYST[Y
II
CONNECT ADDrnONAL MDG.OR S[P'rIC TANK u[P Frr(S)
VVORK TO HOUR[sawnit � - AND/OR DRAINFIE13� -
OVERI<LDW BEEPAO!Prr.DRAINFl[LD 'cEEaPOOL ❑,; RYMftLL❑
KXTN DRYWE MANHOLJK P I -•
ALTER.REPAIR OR ADANDOiN HOUSE ALTER,REPAIL SEWER OR .
BEWER OR DL@POfAL SYBTKM SEWAGE DLHOZ DYST[M
bLBCON►NECT PLUG AND
ABANDON HOUSH SEWER
_ [AC KPI LL B BPT}c TAN K2 Q -
BEEF.Prrts)❑ ca"POOLS❑ .
OWNER'S Permit 1
AUT110RLI+AT1bN TOTAL FEE -VALIDATION =
I HAVE AT THtS-DAT[A CONTRACT WITH THE HEREIN NAMED CON- -
TRACTOR TO CONNECT THE ABOVE DESCRIBED KX0 �' O
TO THE PU BLLC■[MIK R. YA
SIONEDTHLB DAY OF
OWNER OR # 0 0 0 0 1.0
ADDREES - - 2-0 O l a p FI
O oiL 0 1
I HEREBY ACIOtOVYLJDOE THAT I HAVE READ TRtS APPLICATLON 1 a V -
Ahi STATE THAT THE AIOVE IB CORRECT AND AGREE TO COMPLY O O O
WrrH AL1 COUNTY ORDINANCE8 AND STATE L AWl REGULATRNG ,
PLUMBING AND BKVJV - - .
I HEREBY PROPsltl-Y REOIDT[R[D AND/OR I L ! -78
LICSMSED A8 A NOBL[D COU AND STATE OP
ORTN T E LSOAL.. ER O D INTEIND TO RE-
lDs 1 ■D ERTY.
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