HomeMy Public PortalAbout9711 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, COUNTY ENGINEER I BUILDING
ADDRESS � /
1
FOR APPLICANT TO ILLI LOCALITY 7
BUILDING NEAREST
ADDRESS CROSS ST. tYY7 C3 Y1
LOCALITY DISTRLGT N0. SERIAL NO. IPERMIT NO.
4.NEAREST �"I
��
CROSS ST. --
CEIyED BY Ready for Inspection DATE ISSUED
OWNER r .
MAIL USE ZO NE OCCUPANCY BK MAP PG
ADDRESS
CITY TELAO. - (lt�O L
CONTRACTOR r CO.IMP.NO.
ADDRESS �'Z l 40'= ✓/- r r JOB.N0. ` - -
CITY TEL.NO,L.O TRUNK PERMIT NO.3 STATE
- - -
REGISTRATION NO. �� 7 y ® COUNTY ? 76 7 0
ROAD PERMIT N0.
LEGALQUI STATE ENCROACHMENT
DESCRIPTION LOT NO. ` C PERMIT N0.
BLOCK `r TRACTsa y, - a,y � INDUSTRIAL -.
WASTE PPROVAL
SIZE OF LOT u x / /� NOW ON LOTS CHARGES
USE
BUILDINGS CONNECTION CHARGE FEE
<r� ;
NO. DESCRIPTION OF WORK FEE
_ REIMBURSEMENT FEE
HOUSE SEWER CONNECTING TO --
PUBLICSEWER @ $ 3.50 RECEIPT NO. I DATE iBY
�— HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM 1.00
CONNECT ADDITIONAL BLDG.OR EXCEP N RECORDED
WORK TO HOUSE SEWER 1.00
ALTER-OR—RET—AIR EXISTING DATE BY
SEWER OR DISPOSAL SYSTEM 1.00
DISCONNECT AND ABANDON SEWER
AND/OR DISPOSAL SYSTEM 1.00 CONNECTION DATA
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD 2.00 STATION / + 2-I , DEPTH �7
CESSPOOLDRYWELL _ f MA UPPER REFERENCE
SPECIAL CONDITIONS ONLY 2.00
TYPE OF CONNECTION LENGTH FROM
OWNERS PERMIT $ I o0
AUTHORIZATION I TOTAL FEE _ 4
1 HAVE THIS DATE CONTRACTED WITH THE HEREIN NAMED
CONTRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING APPROVALS INSPECTOR'S SIGNATURE DATE
DWELLING TO THE PUBLIC SEWER
SIGNED THIS...........-.......DAY OF_...___ 19 NEW HOUSE SEWER
OWNER OR ��J CONNECT ADDITIONAL
OWNERS AGENT / _ BUILDING OR WORK
SEPTIC TANK,SEEP.PIT(S)
ADDRESS.........................................................................•••- -... AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLI• CESSPOOL E:] DRYWELL
CA
TIONAND 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 1 AM PROPERLY REGISTERED AND
DISCONNECT PLUG
AND/OR LICENSED AS REQUIRED BY LOS ANGELES COUNTY ABANDON HOPLUGAND
AND STATE OF CALIFORNIA OR THAT I AM THE LEGAL OWN-
ER OF THE ABOVE DESCRIBED RESIDENTIAL PROPERTY. BACKFILL SEPTIC TANKS
SIGNATURE / SEEP.PIT(S)E] CESSPOOLS
OF PERMITTE -- -- ------------- ---A-- -------•------------
76A642A 663 7/53 ;,�
COUNTY OF LOS ANGELES TEMPLE CITY- f 0508
DEPARTMENT OF PUBLIC WORKS 9071 LAS TURAS f
- BUILDING AND SAFETY / LAND DEVELOPMENT TEMPLE CITY CA
PHONE: (818) 285-0488 EXT:
LEGAL ID:
ON FILE EXIST OCA GRP:. .
LDGS. NOW ON LOT: CA 917801740
COKNECTICU TYPE: NEAREST CROSS STREET: GOLDEN WEST.
53W-020-017 ORIGINATION: THOMAS PAGE: 597 GRID:" A2 LOCALITY:- TEMPLE CITY,. .
LENGTH. ML TO PL: STATION: DEPTH:
MANHOLE REFERENCE:" UPPER/LOWER:
. PROCESSED BY. EXPIRES .
11/0597UT 11/05/9$."
COUI(TT I}MPROVEIENT NUMBER:
LAM CHECK NUMBER:
CHU RU CHENG V;CEGILIA Y JOB NUMBER:
9711 fAR1BA�DI.AV. TRUK PERMIT NUMBER:
T8W 917801740" ROAD PERMIT NUMBER: L)ESCRIPTIUN UF WORK
FFADAVIT: NO CONNECT NEW ADDITION.TO HOUSE S
WAIVER: NO
EASEMENT- M10 .
HOLLYEVER�CONS..CO. (818) 96871056= .
RECORD INSTRUMENT MBR: .,, -RECORD DATE: SPECIAL CONDITIONS!
HIGIWY/STREET WI I I G:
STATE EN IR.
HOLLYEVER CONSTRUCTION' f 18)'968-1056- VJ
2771 S. RIO LE#PA, DR. tIC. NO FEE CRIti ANOURT:
HACIENDA HEIGHTS,.CA 91745 6379528
q .CE FEM, 27.75
1 S 1.00 30. 0 BUILDING OR WORK
U=al—M ENGINEER: TELII,YEVER.CONSTRUCTION (81¢) % -1056- J FEES �58. SEPTIC
ZTT1 S. RIO LEMPA DR. L C. NO: A]RD/OR DRAIN FJELO
HACIENDA HEIGHTS, CA 91745 632B
SEWER OR
S PAGE. p�E3 L i C WO RS tEWAG DISPos�L SYSTEM
D ABANDON HOUSE SEWER
0 (�
SEER', SIT ` CsSSPOQ(_-ZRAYUkTER SYSTEM
_ -
��. �� o
miC' e
REPORT ID: DPR266 ROUTE TO RSM08