HomeMy Public PortalAbout9829 GARIBALDI AVE_Sewer__I—
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s& _-66311-55 A PPLICATION FOR PERMIT
DIVISION OF BUILDING AND SAFETY SEWER—SEWAGE DISPOSAL 1
Deportment of County Engineer
County of Los Angeles BUILDING
JOHN A. LAMBIE, COUNTY ENGINEER ADDRESS
® CASSATT D. GRIFFIN, SUP'T of BUILDING LOCALITY
FOR APPLICAN FI INNEAR sr. �"•/� { - '- '�r
LEGAL OWNER
DESCRIPTION LOT N0.
BLOCK TRACT MAIL
ADDRESS
NO.OF BLDGS. CITY TEL. NO.
SIZE OF LOT NOW ON LOT
USE OF DISTRICT NO. GROUP MAP
BUILDINGS
y� K
CONTRACTORoil ef
y�/l
CONNECTION DAT
ADDRESS �"
CITY TEL. N0.J STATION Q DEPTH /
r —/7, MANHOLE REFERENCE /O UPPER
REGISTRATION NO. 3 �/ C, ❑ COUNTY l
NO. /
DESCRIPTIONOF WORK !FE
TYPE OF CONNECTION LENGTH FROM S /
/ HOUSE SEWER CONNECTING TO
PUBLIC SEWER @ $3.50 .� Y. CURB .L. M.L. TO P.L.
SEPTIC TANK,SEEPAGE PIT OR
PITS AND/OR DRAINFIELD @ $3.00'
OVERFLOW SEEPAGE PIT,DRAINFIELDP. C. NO.
I
EXTN.,CESSPOOL,DRYWELL,MANHOLE @ $2.00 CO. IMP. NO. JOB NO.
i HOUSE SEWER CONNECTING TO
i 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
SEWER OR DISPOSAL SYSTEM @ $1,00 INDUSTRIAL
WASTE APPROVAL
CHARGES
CONNECTION CHARGE FEE
OWNER'S PERMIT $ 11 Oo
AUTHORIZATION TOTAL FEE REIMBURSEMENT FEE
I HAVE AT THIS DATE A CONTRACT WITH THE HEREIN NAMED CON- APPROVALS DATE INSPECTOR'S SIGNATURE
TRACTOR TO CONNECT THE ABOVE DESCRIBED EXISTING DWELLING
TO THE PUBLIC SEWER. NEW HOUSE SEWER
SIGNED THIS DAY OF 19 CONNECT ADDITIONAL
OWNER OR BUILDING OR WORK
OWNERS AGENT oez
SEPTIC TANK,SEEP,PIT(S)
ADDRESS AND/OR DRAINFIELD
I HEREBY ACKNOWLEDGE THAT 1 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 I AM PROPERLY REGISTERED AND/OR DISCONNECT PLUG AND
LICENSED AS REQUIRED BY LOS ANGELES COUNTY AND STATE OF ABANDON HOUSE SEWER
CALIFORNIA OR THAT I AM THE LEGAL OWNER OF THE ABOVE
DESCRIBED RESIDENTI,L PROPERTY. BACKFILL SEPTIC TANKS❑
SIGNATURE / / SEEP.PIT(S) ❑ CESSPOOLS❑
OF PERMITTEE
JOHN A. LAMBIE, COUNTY ENGINEER VALIDATIOROBERT A. WOOD, CHIEF PLEIG. INSPECTOR
0. CASH
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