HomeMy Public PortalAbout9824 GARIBALDI AVE_Sewer__ APPLICATION FOR PERMIT 1
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DIVISION of BUILDING AND SAFETY. SEWER—SEWAGE DISPOSAL
D.p-tn.nt of C —ty Enghma
COmiT Of Las Angel" BUILDING
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JOHN A. LAMBIE. COUNT! ENGINEER
m CASSATT D.GRIFFIN. SUPT OF BUILDING LOCALITY Y
FOR APPLICANT TO FILL IN OSS ST.
LEGAL 7✓ �� OWNEER
DESCRIPTION LAT N0.
MAIL
BLOCK TRACT ADDRESS is _
NO. OF BLDGS. CITY TEL N0.
SIZE OF OT NOW ON LOT
UDE OF DISTRICT X0. GROUP MAP
CONTRACTOR GD HK
CONTRACTOR
ADDRESS CONNECTION DATA
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CITY — N TEL N0. / of DTA710N (1 PTH '
J MANHOLE REFERKXCEid
' aDTATE
REGISTRATION N0. Z r. J ❑ COUNTY
No, DESCRIPTION OF WORK FEE
HOUSE SEWER CONNECTING TO TYPE 01< CONNECTION LENGTH FROM /
PUBLIC SEWER S.SO Y. CURB P.L. Y.L.TO P.L
SE"Id TANK,SEEPAGE PIT OR '
PITS AHD/0R DRAINFIELD 8 5.00
OY£RFI, S EPAGE PIT,DRAINFIELD P. C. o.
I
EXTX.,CESSPOOL DRYWELL MANHOLE 2.00 CO. IMP. N0. JOB NO.
I
HOUSE SEWER CONNECTING TO -
I PRIVATE DISPOSAL SYSTEM 0 11.00 JIZUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL BLDG_OR ATE ENCROACHMENT _ b�
WORK TO HOUSE SEVER 8 1.00 ERMIT N0.
ALTER,REPAIR 09 ABANDON HOUSE
SEWER OR DISPOSALSYMM 1.00 WAST TRIAL
WASTE APPROVAL
-XTI O CHARGES
CONNECTION CHARGE FEH
OWNER'S PEBMIT . s
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIO DATE A CONTRACT WITH THE HEREIN NAIED COX- APPROVALS DATE INSPECTOR'S>IGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC, SEWE1;. MEW HOUSE SEWER
SIGNED THIS SAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT SEPTIC TANK,SEEP,PUT(a)
ADDR AND/OR DRAIXFIQLD
I HEREBY ACKNOWLED6FQ THAT 1 HAVE READ THIS APPLICATION CSPOOL❑ DRYWELL❑
AND STATE THAT THE ABdYH IS COES
RRECT AND AGREE TO COyyR17
WITH ALL COUNTY ORDINANCES AND STATE LAWS REG 11(6 ALTER,REPAIR,SEWER OR
PLUMBING AND SEWERS. SEWAGE DISPOSAL SYSTEX
1 HEREBY CERTIFY THAT I AY PROPERLY REGISTERED "D/OR DIDCDrr13CT PLUG AND
LI4ENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF
C9IFORNIA OR THAT I THE LEGA OWNER OF THE ABOVE ABANDO HOUSESKWER
DESCRIBED RESIDENTIAL OFERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE SEEP.PITO ❑ CESOPOOL9
OF PERYI
I —S"6
JOHN A. LAMBIE C.4fiNTY ENGINEER _J/ALMATION ROBERT A.WOOD, CHI[F PL.DG. INSPECTOR
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X.0. c"m
24. 60 NQV19 5 25.00
7 �e
a4�DAPPLICATION FOR PERMIT
WMON OF BUILDING AtID SAFETY SEWER-S EWACI E DISPOSAL 1
D%N=t-nt of Conan MWb3 w
Co=t7 of Los kw" •UILDIN4
JOHN A- LAMBIE, COUNTY P-NOINNER ADDRESS
m CASISATT D. ORIP'FIN, SUF'T OF BUILDtrya
OF
EAREST
FOR APPLICAN'JT� TO FILL IN-' XCRROSSLEGAL
rr
DISCRIFTION LOT NO.Rnr + 6 OWN ER
RAIL
BLOCK TRACT ADDR
NO.Ole SLDGs. TEL- XO. "f
SIZ=OF LOT NOW OX LOT cl
UDE OFI
DING)!
BUILDIDISTRICT N0, GROU YAP
BK P
CONTRACTOR
ADDRESS COMMCTIO I DATA
` STAnON114 H
CITY THL. Q3 RAXHOLE R$FER"CE
ATE W
REGISTRATIONX0. ❑ COUNTY
NO. DESCRIPTION OF WORK FEE TYPE OF CONNECTION - LENGTH FROM
i
HOUSE SEWER CONNECTING TO Y. CURB P.L. Y.L.TO P.L
PUBLIC SEWER B 3.50
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAIXFIELD 40 3.00
OVERFLOW SEEPAGE PIT, DRAINFIELD P. C. NO.
N.,CESSPOOL,DRYWELL AN-HOLE ® 2.00 CO. lop. N0. JOB N0.
HOUSE SEWER COX ECTING TO -
PRIVATE DISPOSAL SYSTEM 0 S 1.00 TRUNK PERMIT NO. ROAD PERMIT NO.
CONNECT ADDITIONAL RLDG.OR STATE ENCROACHMENT
WORK TO HOUSE SEWER 0 x.1.00 PERMIT X0.
ALTER,REPAIR OR ABARDQX HOUSE INDUSTRIAL
SEWER OR DISPOSAL SYSTEM ® 1.00 WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
ovnmlS PE MT ; 1 00 ,!
AUTHORIZATION TOTAL FFA REIMBURSEMENT FEE i✓EE�7"QB- /4lO ��� CSY'P1L
1 HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NA EDCON- APPROVALS DATH INSPECTOR'S 81GNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC S ER. NEW MOUSE SEWER Z
SIGNED THIS OF 1 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENTSEPTIC TANK,SEEP,PIT,(S)
ADD ESS /0 AND/OR DRAINFIELD
1 HEREBY ACKNOWLEDGE THAT IHAVE READ THIS APPLICATION CESSPOOL❑ DRYWELL❑
AND STATE THAT THE ABOVE 18 CORRECT AND AGREE TO COMPLY
WITH ALL COUNTY ORDINANCES AND STATE LAWS REGULATING ALTER,REPAIR,SEWER OR
PLUMBING AND HEWERS. SEWAGE DISPOSAL SYSTEM
I HEREBY CERTIFY THAT 1 AY PROPERLY REGISTERED AND/OR
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF DISCONNECT PLUG AND
CALIFORNIA OR THAT I Y THE �LEQALMER OF THE ABOVE ABANDON HOUSE SEWER ,
DESCRIBED RESIDENTIAL OPERTY. BACKFILL SEPTIC TA1XKS❑
SIGNATURE S P.PIT(S) ❑ CEJSPOOLS❑ -
1 - 16 OF PERMITTEE
JOHN A. LAMBIE. C NTY ENGINEER VALIDATION ROBERT A.WOOD, CHIEF PL13G. INSPECTOR
CDY.0. CASH
LE02 NN 19 4 4.550 0