HomeMy Public PortalAbout9821 GARIBALDI AVE_Sewer__ I
D
S E-689 1i-55
APPLICATION FOR PERMIT 1
S&E-6
DIVISION OF BUILDING AND SAFETY SEWER-SEWAGE DISPOSAL
Deportment of County Engineer
County of Los Angeles FADDRESS
ING
JOHN A. LAMBIE, COUNTY ENGINEER CASSATT D. GRIFFIN, SUPT of BUILDING LITY
FOR APPLICIffiT TO FILL IN NEAREST4!ROSS ST.
LEGAL
OWNER
DESCRIPTIOON�y�7�LO�OT O.
MAIL
BLOCKS A*lr/RA AN%rA ADDRESS
"^� u O�YNO. OF BLCITY TEL. NO.
_SIZE OF LOT � /�/ 7 NOW ON LOTT
USE OF
BUILDINGS jfi DISTRICT NO. _,GROUP V P
CONTRACTOR
ADDRESS 7— CONNECTION DATA
/� Q "'�- �~ /
CITY � � I TEL. NO. � C �J�VO STATION DH� MANHOLE REFERENCE UPPER
REGISTRATION NO. /� � ` El STATE
TY OWER
NO. DESCRIPTION OF WORK ♦ FEE TYPE OF CONNECTIOLENGTH FROM
HOUSE SEWER CONNECTING TO Y. CURB P.L.L. M.L. TO P.L.
PUBLIC SEWER @ $3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00
OVERFLOW SEEPAGE PIT,DRAINFIELD CO. IMP. NO. JOB
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 NO
HOUSE SEWER CONNECTING TO
PRIVATE DISPOSAL SYSTEM @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG.OR STATE ENCROACHMENT
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
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
IHAVE AT THIS DATE A CONTRACT WITH THE HEREIN N MED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER _ Z ..y g �___ f
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR .� BUILDING OR WORK
OWNERS AGENT_L %'
SEPTIC TANK,SEEP,PIT(S)
ADDRESS _AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT I HAVE READ 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 1 AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT
ABANDON CT PLUGHOUSE AND
CALIFORNIA OR THAT 1 AM THE LEGAL OWNER OF THE ABOVE
WER
DESCRIBED RESIDEN PROPERTY, BACKFILL SEPTIC TANKS I-]SIGNATURE / SEEP.PIT(S) L:1CESSPOOLS C:1OF PERMITTEE ZJ
JOHN A. LAMB E, COUNTY ENGINEER VALIDATION ROBERT A. WOOD, CHIEF PLBG. INSPECTOR
CK. M. 0. i�;YXN
Act)21924 4 A 454
, °
CEB0811_57 APPLICATION FOR PERMIT
E808 1
COUNTY OF LOS ANGELES SEWER—SEWAGE DISPOSAL
DEPARTMENT OF COUNTY ENGINEER
BUILDING AND SAFETY DIVISION BUILDING
( I
JOHN A.
LAMBIE, County Eng neer CASSATT D. GRIFFIN, Supt of BuildingLOCALITYNEAREST ,..
FO AE_ PCANT TO FILL IN ! CROSS ST. f"
LEGAL �
` ,'` r ,.„✓,, f' h..,,-' s
DESCRIPTION' LOT NO,. OWNER
r BLOC " T A .. .. .. MAIL -
ADDRESS
N0:OF BLDGS.
SIZE OF LOT 'f `' NOW ON LOT CITY TEL.N0.
USE OF
BUILDINGS ^y
i DISTRICT N0. GROUP I MAP
CONTRACTOR ,ti'.!' BK PG,
ADDRESS :, ,�—• <— CONNECTION DATA
i' CITY TEL.NO. C' ! STATION -+ r DEPTH
❑ STATE MANHOL REFERENCE e —tT UPPER
REGISTRATION N0. ❑/ _ +�( '/aF COUNTY
N9. DESCRIPTION OF IVRK
HOUSE SEWER CONNECTING TO
PUBLIC SEWER @
SEPTIC TANK,SEEPAGE PIT OR TYPE OF CONNECTION—'•-- LENGTH FROM /
P.L.
PITS AND/OR DRAINFIELD @ $3,00 Y. CURB M.L.TO P.L.
OVERFLOW SEEPAGE PIT,DRAINFIELD
EXTN.,CESSPOOL.DRYWELL,MANHOLE @ $2.00
HOUSE SEWER CONNECTING TO P.C. N0, r
PRIVATE DISPOSAL SYSTEM @ $1.00 Gpw.1P.-NO. ,[Q$,�(p, �✓"`. :,,w�
CONNECT ADDITIONAL BLDG.OR
WORK TO HOUSE SEWER @ $1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
ALTER,REPAIR OR ABANDON HOUSE
SEWER OR DISPOSAL SYSTEM @ $1.00 STATE ENCROACHMENT
PERMIT NO.
INDUSTRIAL
WASTE APPROVAL`
-CHARGES
OWNERSPERMIT $ 00 CONNECTION CHARGE FEE
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON. No Gz
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING APPROVALS DATE INSPECTOR'S SIGNATURE
TO THE PUBLIC SEWER.
SIGNED THIS DAY OF 19 NEW HOUSE SEWER
OWNER ORCONNECT ADDITIONAL
OWNERS AGENT 9.��,.r<-4"'�'-`"^� BUILDING OR WORK
ADDRESS SEPTIC TANK,SEEP, PIT(S)
AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT 1 HAVE READ THIS APPLICATION
AND STATE THAT THE ABOVE IS CORRECT AND AGREE TO COMPLY CESSPOOL❑ DRYWELL❑
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING
PLUMBING AND SEWERS, ALTER,REPAIR,SEWER OR
1 HEREBY CERTIFY THAT I AM PROPERLY REGISTERED AND/OR SEWAGE DISPOSAL SYSTEM
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE ABANDON HOUSE SEWER
DESCRIBED RESIDENTI L :PROPERTY. BACKFILL SEPTIC TANKS ❑
SIGNATURE SEEP. PIT(S) ElCESSPOOLS ❑
6 OF PERMITTEEr
OF VALIDATION ROBERT A. WOOD
CK. M.0. CASH - SUPERVISING MECHANICAL,ENGINEER
1
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