HomeMy Public PortalAbout9665 GARIBALDI AVE_Sewer__ 7fAfffD !7�`e-, I
mom f-ff APPLICATION FOR PERMIT
COUNT? OF Los ANGM SEWER—SEWAGE DISPOSAL
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BUMMG AND 8AF8TT DIVIE90N FkDDRX&S9665&7
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GAL
DESCRIPTION LOrNO. Weld 52t of lot A OWN EY
BLOCK cT a IAnd Co.,Trao ADDRESS
ntr lb F
SIZE OF LOT r,
'0j,0M
LOT C
"'OF
BUI IR D STRICT X0. GROUP
BL PG LAP P CFSSID BY
iT^
C01fTRACTOQ IASIS P ing
7
i 4 X4.,�
ADD , Lee Ave. COXNECMON DATA
Cm MnrrhpTEL X0. STATION DEPTH
STATE
REGISTRATION-N0. COUNTYMANHOLE 2270LENCE UPPER
No PON OF WORK FEE
XffCe COXXECTIXG TO 5.00
n n La FRO
SBPTIC TI�XR,SEEPAGE PIT OR T. UttB P N.L.TO P.L.
PIT$AIID/OR DCAIXF1ELD D
VERFLOW SEEPAGE PIT DRAINFIELD
00
HOUSE SENECONNEC7IXG TO P 0.
PRIVATE 1 100 CO.ILP.N0. B 110.
SAOIIbFCT AADITIOXAL BLDG.OR 2 TRUNK PERUTT n0. ROAD PEY](IT R0. �
A M.NSISFut iu HOUIIIREOSRE'AAB�A 11(HOUSE STATE KXCFIDACH■
1•DO PERMIT NO.
INDUSTRIAL
WATMkPPROAL
CHARGES
O'fes PEffi►4T CONNECTION CHARGE FEE
AUTHOEMTION TOTAL FEE 4RnreurtBBLBNT FEL{
1 HAVE AT THIS DATE A CONTRACT WITH THE HMMN NAMED C0111-
TIAGTOR TO CONNECT THE ABOVE DESCRIBED MVT1NG DW>UJIIG APPHOVAM DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWIX I
SIGNED THIS AAY OF- ID_ IIEW HOUSE$EWER
DWNER OR CONNECT ADDITIONAL. +�
OWNERS AGENT BUILDING OR WORK t71 I
ALDppESI SEP"TIC TANK,SEEP.PIT(3)
f AND OQ DQAINF1ELD
1 HEREBY ACKNO71-EDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT 1`146 ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL D
WITH ALL COUNTY ORDINANCES AND STATE LAWS .REGULATING ��.REPAIR,��OR
PLUMBING AND SEVERS. SEWAGE EPAIR,SDISPOIAER OR
1 HEREBY CERTIFT THAT I AL PROPERLY REGLSTERM AND/OR DISCONNECT PLUG
EM
LICENSED AS REQUIRED BAND
T LOS ANGELES COUNTY AND STATS OF ABANDON HOUSE SEVER
CALIFORNIA OR THAT I AL TH LEGAL OWNER OF THY ABOYE
DESCRIBED ILESM 0P BACKFILL SEPTLC TANKS
SI G MTURS
SEEP.PITS CFMPOOLS
OF PQM
OF ATION -ROBERT A. WOOD
az X.G.. GUM 6UPMtYLeINQ M=iANICAL M.NQINMM
l� ,01 2 0 2 5 SL ty 2 3 1 0 A 4.0 0
"""' APPLICATION FOR PERMIT
a�.o. .-., 1
COUN17 of LOS ANGM SEWER—SEWAGE DISPOSAL
MARTMM OF CovxrY ENCiRC=
BUIIMIG AND SAFETY D!VIMON BU No
f
�YO CouwT ADD
C'. CFJs
ASLM A . Oup•t o!St�1Qla� LOCA
FOR APPLICANT TO FILL IN CROSS ST.
LEGAL.
DESCRIPTION LOT 110. / oWN1m
BLOCK TIIACT MAIL
ADDRESS
R BLD
SIZE OF LOT X01 OX LAT cm TEL IqO.
USE OF
BUILDINGSKDdRTDISTIIICT X0. GR6UP
YAP P
B[ Pta
CONTRACTOR �
ADDRESS b COI�!(EGTION ara
CITY TEL NO. STITION DEM
ff"ITATI ■ANHOLE REFELLENCE UPPER
RE 91STRAn011 X0. C
ONT
T
NO D O 0 FEE
[OUSILBE�F$_CONXECTI G TO
SEPTIACP SS5EW7�ERR 43.Do TTPE OF COXXECnoX L[XGTfl R
SEPTIC D/NR.SEEPAGE PIT OR T. CURB P N.L.TO P4,41
PITS AXD/OR DRAINF1ELD
OVERFLOW SEEPAGE
C PIT DZIXFIEID
RD aE
TMER connecTl aro
C TO qp 00
ADU 5TIgXALDG.OR
� 0 51.09
HOUSE
,
STATE EMCROACHpMET
STEM 9 OO naa■rotlTyp
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL,
CHARGES
OWLS PEST 00 COXNECnON CHARGE FU
AMEOETdATION TOTAL FEE RnMBURSEEENT FEE
I FIAVE AT THIS DATE A CONTRACT WITH TPE HEREIN IIAY» CON-
TRACTOR TO CONNECT THE ABOVE DESCRIBED mSTINB DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS- Y OF 19_ NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT BUILDIX4 OR RORx
ADDSEPTIC TAN[,SEEEEP.PITS)
AND/OR DRAINF)[LD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE1p CORRECT AND AGREE TO COMPLT CESSPOOL DRTWELL
WITH ALL COUNTT ORDIXANCIif AND STATE LAWS REGULATING ALTER,REPAIR SEWER OR
PLULBING AND SEVERS. SEWAGE DISPOSAL STSTE■
L HEREBT CERTIFY THAT IAN PROPERLT REGISTMM AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BT LDS ANGEIFS COUXTT AND STATE OF ABANDON HOUSE SERER
CALIFORNIA OR THAT I AN THE GAL OWNER OF THE ABOV[ C TANKS
DESCR1BiLD RFdID PEYTTBACKFILL S P PIT E CEB11P00
519 XATU RIC
OF PERK
VAIIDATIO - ROBERT A. WOOD
CL L 0. ¢W SUPBOZ MING NYCHANICAL KNOINYER
L,C0 0 3 6 6 MAY 51 OA 3.0 0 :R
-17aAa-41DAPPLfCATIOfV--FOR PERMIT
••X.061 11.64 - - 1
DMMON OF BUMDING AND SAFETY SEWER-SEWAGE DISROSAL
D.parbn.1 oclrr a.
� of Awa F6ODRESS
NG WM.J, FOX, COUNTY EN4IINQR CAl�ATT Tl.pRIFFIN,*1JT'T OP 1utLawd TY
FOR APPLICANT TO FHl IIT NEAREST
CRO"ST.
LEGAL
DESCRIPTION LOT NO. 9"EE
3L CX RACT
TAN MAILQ
ADDRE1i �1
1 ii / NO OF BLD GE,
SIZE OF LOT J 00 III OR LOTCI7YTF
PLE CtTFL. X0. 4`2-S'
USE OF
BUILDIMG3 bISTRICT No. GROUP YAP
Ir ::T: 1 4
CONTitACTOR
ADDRESS �.<j - // s / CONNECTION DATA
CITY A— A- TEL. 140./'�' STATIOR [� DEPTH / J
0 STATE / MATAFJiC[
REGISTRATION NO. Io f ❑ COUNTY O PP LAR
TYPE OF CONNE LENGTH PROs[
No. DESCRIPTION OF WORK Fq¢ Y. CURB .L. M.L. o P.L
/ HOUS9 SWWER CONNECTING TO
[ PUBLIC SEWER 3.60 11 Jz
HOUSE SZWtR CONNECTING TO
PRIVATE'DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG. OR f &o CO. imp. N0. / 3 N0.
WORRTO HOUSE SEWER 1.00 I
ALTER OR REPAIR EXISTING
SEWER OR DISPOSAL SYSTEM 1100 TRUNK PERMIT NO. ROAD PERMIT XO,���d
DI¢C NNECT AND ABANDON SEINER pTATE HXCROACHMIi T
AND/OR DISPOSAL SYSTEM 1.00 PERMIT NO.
SEPTIC TANK, SEEPA PIT OR
PITS ANDI(/OR DRAIRPIE0 2.00 �Np USTR IAL
SPECIAL CONDIONS ONLY 2.00 WASYH APPROVAL
CHARGES
CONNECTION CHARGE F$E
OWNES'S PE AUT $ 00
AUTHORIZATIONTOTAL FES. REFABURS£M^Nt FEE
1 HAVE THIS DATE TNTRACTED 'I'ITN THE HEREM NAMED CO�1- =T Q DATE IN§PECTOfi S 816NATURf
TRACTOR TO CONNECY THE ABOVE DESCRIBED EXISTING DWELLIII GS ovAi �
TO THE PUBLIC. SEWED(
SIGNED THIS 1'I DAY D NEW NOUSE$LwOWNERt
„o CT ADDITIONAL
BUILDI - .
BUILDING OR WORK
SEPTIC TARE,SEEP, PIT($)
ADDRESS- AND 011 DRAT FIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLIC,�TIOX CES➢POOL❑ DRYWELL❑
AND BTATY THAT 7'H6 ABOVE IG CORRE AXb AGREF TO COMP44Y
WITH ALL COUNTY ORDINANCYD AMD STATE LAWS RRQULATIMG AL ¢t REPAIR,SEWER OR
PLU-MBLNG AND SEllr�iS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT I AM PROPERLY REY)ISTERED AND/OR
LICENSED AS REQUIRED BY LOQ ANGELES COUNTY AND STATE {IF D18COXR9CT PLUG AND
CALIFORNIA OR THAT, I AM THE LEGAL OWNER OF TIM ABOVE ABANDON-MOUSE SE LR.
R.q ,7
DESC-RIBED RI$IDENTIAALL/PROPERTY. 11 ACKJqLL$QP.PITS CCBMIFOoLf 1 V
SIGNATUREOF PERMITIEff
WIL-LkM J. FOX,CoumT)rL ENaimum VALIDATION
Q-"?$.t3 f823 4 615 '9
DRPUTY DEPUTY
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