HomeMy Public PortalAbout9815 GARIBALDI AVE_Sewer__ D
5&E-663 11.55 APPLICATION FOR PERMIT 1
5&E-6
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, SuP'T OF BUILDING LOCALITYNEAREST
FOR APPLICANT TO FILL IN CROSS
LEGAL It/IFF �_ OWNER
DESCRIPTION LOT N0.
MAIL
BLOCK TRACT �,',� ,, .,� �,�1� ADDRESS tM/
/ 7 ,/�,y N0. OF BLDGS. °
SIZE OF LOT,4 (/Co NOW ON LOT CITY �A EL. NO.
USE OF _?
F
BUILDINGS ^�-liQ
DISTRICT NO. GMAP I PG
CONTRACTOR` (oj
ADDRESS
CONNECTION DATA
Z •3 � ��j
�O ® STATION DEPTH
CITY TEL. N0. '� PA MANHOLE REFERENCE UPPER
TLOWER
REGISTRATION NO.Z"..a,y." ,� ���� ❑ COUNTY
No. DESCRIPTION OF WORK FEE -
HOUSE SEWER CONNECTING TO tIll TYPE OF CONNE ION GTH FROM
PUBLIC SEWER @ $3.50 Y• CURB P.L. .L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD P. C. NO.
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO.
HOUSE SEWER CONNECTING TO -
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT N ROAD PERMIT NO.
j CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
/5 WORK TO HOUSE SEWER @ $1.00 PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM @ $1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 1 00
REIMBURSEMENT FEE
AUTHORIZATION TOTAL FEE 3 -T**>e) r
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTORS SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL r
OWNER OR BUILDINGSOR WORK
OWNERS AGENT Azzg2 �� SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION CESSPOOL ElDRYWELL ElAND 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
1ICHEREBY CERTIFY THAT 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DI
HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTIAL PROPS TY. BACKFILL SEPTIC TANKS[�
SIGNATURE SEEP.-PITS) ❑ CESSPOOLS[I
OF PERMITTEE LLL
JOHN A. LAMBIE, COUNTY ENGINEER x-YALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. J h.0. CASH
ij"O 7 5 IN MAY 12 4 A 3 0 0 ;s